Cause of death and factors associated with early in-hospital mortality after hip fracture

Abstract

The aims of this study were to identify the early in-hospital mortality rate after hip fracture, identify factors associated with this mortality, and identify the cause of death in these patients. A retrospective cohort study was performed on 4426 patients admitted to our institution between the 1 January 2006 and 31 December 2013 with a hip fracture (1128 male (26%), mean age 82.0 years (60 to 105)). Admissions increased annually, but despite this 30-day mortality decreased from 12.1% to 6.5%; 77% of these were in-hospital deaths. Male gender (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.3 to 3.0), increasing age (age ≥ 91; OR 4.1, 95% CI 1.4 to 12.2) and comorbidity (American Society of Anesthesiologists grades 3 to 5; OR 4.2, 95% CI 2.0 to 8.7) were independently and significantly associated with increased odds of in-hospital mortality. From 220 post-mortem reports, the most common causes of death were respiratory infections (35%), ischaemic heart disease (21%), and cardiac failure (13%). A sub-group of hip fracture patients at highest risk of early death can be identified with these risk factors, and the knowledge of the causes of death can be used to inform service improvements and the development of a more didactic care pathway, so that multidisciplinary intervention can be focused for this sub-group in order to improve their outcome.

In-hospital mortality does not increase in patients aged over 85 years after hip fracture surgery. A retrospective observational study in a Japanese tertiary hospital

“…In this study, we found, firstly, that in-hospital mortality did not differ between aged and advanced age groups, which was confirmed by a univariate analysis and binominal multivariate logistic regression analysis, secondly, that in-hospital morality was low in both groups as compared to the reported values [1,2], and, thirdly, that most patients died from advanced cancer or aspiration pneumonia.…”

“…First, the in-hospital mortality in this study was less than that previously reported from western countries. Even in those studies, the odds ratio of age among patients aged over 70 years is relatively small [1,6]. Age should thus be considered as a risk only at the extremes of age, i.e., over 95 years [7].…”

“…Preoperative assessment of these functions would be of help identifying patients at risk and thus prevent such complications after surgery. In their retrospective study, Chatterton et al [1] also showed that the most common cause of death was respiratory infection. Preoperative identification of patients at highest risk for early death would help in tailoring surgical management and improving postoperative outcome, but further study is needed.…”

“…Reports from the UK and US indicate that 30-day postoperative mortality and morbidity are still high, at 6.5 and 5.2%, respectively [1,2]. Although age is one of the significant predictors for increased mortality, it may actually be a surrogate measure for other variables, especially since frailty or reduced functional capacity rather than chronological age predict postoperative mortality after surgery overall [3][4][5].…”

Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them

“…The co-existence of significant comorbidities, dementia and difficulties in pain management constitute the medical management of these patients challenging [3][4][5]. Despite recent advances in surgical and medical management of elderly patients with hip fractures latest relevant research has shown that the one year post-injury associated mortality is still high ranging from 18.8% to 22.8% and increases with age [6][7][8][9].…”