Determinants of mortality after hip fracture surgery in Sweden: a registry-based retrospective cohort study

Abstract

Surgery for hip fractures is associated with high mortality and morbidity. The causes of poor outcome are not fully understood and may be related to other factors than the surgery itself. The relative contributions of patient, surgical, anaesthetic and structural factors have seldom been studied together. This study, a retrospective registry-based cohort study of 14 932 patients undergoing hip fracture surgery in Sweden from 1st of January 2014 to 31st of December 2016, aimed to identify important predictors of mortality post-surgery. The independent predictive power of our included variables was examined using Cox proportional hazards modeling with all-cause mortality at longest follow-up as the outcome. Twelve independent variables were considered as interrelated ‘exposures’ and their individual adjusted effect within a single model were evaluated. Kaplan-Meier curves were also generated. Crude mortality rates were 8.2% at 30 days (95% CI 7.7–8.6%) and 23.6% at 365 days (95% CI 22.9–24.2%). Of the 12 factors entered into the Cox regression analysis, age (aHR1.06, p < 0.001), male gender (aHR 1.45, p < 0.001), ASA-PS-class (ASA 1&2 reference; ASA 3 aHR 2.12; ASA 4 aHR 4.79; ASA 5 aHR 12.57 respectively, p < 0.001) and PACU-LOS (aHR 1.01, p < 0.001) were significantly associated with mortality at longest follow-up (up to 3 years). University hospital status was protective (aHR 0.83, p < 0.001) in the same model. Age, gender and ASA-PS-class were strong predictors of mortality after surgery for hip fractures in Sweden. University hospital status and length of stay in the postoperative care unit were also identified as modifiable risk factors after multivariable adjustment and require confirmation in future studies.

Hypnotic depth and postoperative death: a Bayesian perspective and an Independent Discussion of a clinical trial

“…3 Independent Discussion: Reducing mortality in this population may prove challenging given the urgent nature of surgery and comorbidity-driven risk factors. 10,11 Surgical factors (e.g. bone cementation 11 ) could be further explored.…”

“…Comorbidity burden may be a significant driver of postoperative mortality after hip fracture, as demonstrated here and in prior investigations. 10,11 Commentary: In the Original Discussion, the investigators focus on reasons why the findings of the current study were different from a smaller previous study with a similar design done by the same team. 6 The Independent Discussant notes that while there has been little research examining whether depth of sedation affects outcomes after hip fracture surgery, several clinical trials and observational studies have investigated whether the outcomes are different after general anaesthesia vs regional anaesthesia.…”

Dementia and CSF‐biomarkers for Alzheimer's disease predict mortality after acute hip fracture

“…All study patients received spinal anesthesia (with Bupivacaine and Fentanyl), as is routine for 85% of AHF‐patients in our department. There are no large prospective studies demonstrating any advantage of neuro‐axial or general anesthesia on mortality, and the effects of anesthesia per se were not further scrutinized in this investigation.…”

“…An acute hip fracture (AHF), the second most common orthopedic fracture type in Scandinavia (and other regions), represents a major trauma, affecting elderly, often frail, patients, with considerable risk for poor outcome. Mortality is high, 7‐11% at 30 days, 10‐20% at 90 days, 25‐40% at one year, and about 50% three years after surgery . The patient's autonomy and quality‐of‐life is often restricted after AHF.…”

The influence of time‐to‐surgery on mortality after a hip fracture

“…The fracture per se is a severe trauma to the individual, inducing pain as well as short‐ and often long‐term disability. The mortality rates, after an AHF, are approximately 6%‐8% at 30 days increasing to 23%‐29% at 1 year . The mortality rate increases by age, male gender and the presence of comorbidities, predominantly heart failure and pulmonary infections …”