Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients

Padrón-Monedero, Alicia; Ortíz, Cristina; Galán, Iñaki; Sánchez, Elena Vanessa Martínez; Martin, Pilar; Fernández-Cuenca, Rafael

doi:10.1007/s00198-017-3926-2

Cited by 40 publications

(40 citation statements)

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“…Although comparison with earlier studies is hampered by differences in definitions of the outcome (ie, in-hospital, 1 year, and overall mortality) and in the identification of patients with liver disease, our findings are on the whole in accordance with those of six earlier studies. 7 , 8 , 11 – 14 A recent study reported absolute 30-day mortality in patients with alcoholic liver cirrhosis compared to general population (matched by age and gender) to be 11.5 vs 5.0% in England and 10.0 vs 6.6% in Denmark. 7 The adjusted mortality risk ratio comparing deaths among patients with alcoholic cirrhosis to controls was 2.8 (95% CI: 1.9–3.9) and 2.0 (95% CI: 1.5–2.7) for England and Denmark, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence regarding the specific impact of liver diseases is mostly limited to studies that examined prognostic role of liver disease among several other comorbidities. 7 , 8 , 11 – 14 Mortality risk among HF patients with liver disease compared to those without liver disease was twofold to fivefold increased for in-hospital 11 , 13 , 14 and 30-day 7 mortality and nearly twofold increased for 1 year 12 and overall mortality. 8 No previous studies have specifically examined the impact of noncirrhotic liver disease and liver cirrhosis on mortality in the first and subsequent months following HF in a population-based setting.…”

Section: Introductionmentioning

confidence: 96%

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Liver disease and mortality among patients with hip fracture: a population-based cohort study

Montomoli¹,

Erichsen²,

Gammelager³

et al. 2018

CLEP

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PurposeThe aim of this study was to examine the prognostic impact of liver disease on mortality following hip fracture (HF).Patients and methodsThis nationwide cohort study, based on prospectively collected data retrieved from Danish registries, included all patients diagnosed with incident HF in Denmark during 1996–2013. Patients were classified based on the coexisting liver disease at the time of HF, ie, no liver disease, noncirrhotic liver disease, and liver cirrhosis. We computed 30-day and 31–365-day mortality risks. To compare patients with and without liver disease, we computed mortality adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using Cox regression controlled for potential confounders.ResultsAmong 152,180 HF patients, 2,552 (1.7%) patients had noncirrhotic liver disease and 1,866 (1.2%) patients had liver cirrhosis. Thirty-day mortality was 9.4% among patients with noncirrhotic liver disease, 12.6% among patients with liver cirrhosis patients, and 9.7% among patients without liver disease. Compared to patients without liver disease, crude and adjusted HRs within 30 days following HF were, respectively, 0.96 (95% CI: 0.85–1.10) and 1.24 (95% CI: 1.09–1.41) for patients with noncirrhotic liver disease and 1.30 (95% CI: 1.14–1.48) and 2.25 (95% CI: 1.96–2.59) for those with liver cirrhosis. Among patients who survived 30 days post-HF, the 31–365-day mortality was 18.5% among patients with noncirrhotic liver disease, 26.4% among patients with liver cirrhosis, and 19.4% among patients without liver disease. Corresponding crude and adjusted HRs were, respectively, 0.95 (95% CI: 0.86–1.04) and 1.08 (95% CI: 0.99–1.20) for patients with noncirrhotic liver disease and 1.40 (95% CI: 1.27–1.54) and 1.91 (95% CI: 1.72–2.12) for those with liver cirrhosis.ConclusionLiver disease patients, especially those with liver cirrhosis, had increased 30-day mortality and 31–365-day mortality following HF, compared to patients without liver disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Liver disease and mortality among patients with hip fracture: a population-based cohort study

Montomoli¹,

Erichsen²,

Gammelager³

et al. 2018

CLEP

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“…The higher mortality rate identified for men might be partly explained because men suffer from more comorbidities and poorer health than women of the same age, which could worsen the harmful consequences of fractures [ 14 , 19 ]. However, although Hindmarsh et al have suggested that a greater number of comorbidities are associated with a higher lethality due to fractures caused by falls in older people, the excess mortality from hip fractures in men persists even after adjusting for comorbidities [ 25 , 26 ]. This excess of mortality rates from accidental falls in men over 64 years compared with women deserves further study.…”

Section: Discussionmentioning

confidence: 99%

“…Apparently, the improved survival in a population with a high number of comorbidities could place them in a condition of frailty [ 16 ]. On the other hand, it has been suggested that the association between age and mortality after hip fracture remains after adjusting for numerous comorbidities, therefore could be of interest to assess the impact on mortality of specific indicators of frailty (performance of daily activities, healthy attitudes, and variables related to function and nutrition), taking into account pertinent comorbidities [ 26 ]. Moreover, we cannot rule out that the economic crises that started in 2007 could have affected the frailty of the older population through different ways.…”

Section: Discussionmentioning

confidence: 99%

Mortality trends for accidental falls in older people in Spain, 2000-2015

et al. 2017

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BackgroundAccidental falls in older people are a major public health problem but a relatively limited number of studies have analyzed the mortality trends from this cause. Effective public health interventions have been found to prevent the incidence of falls and their complications. Therefore, characterizing the mortality trends of falls for different subpopulations can help to identify their needs and contribute to develop more appropriate prevention programs for specific target groups.MethodsThis study was based on a longitudinal analysis of death rates from accidental falls (2000-2015) stratified by sex for the population ≥ 65 years and by age groups (65-74, 75-84, ≥85). A joinpoint regression model was used to identify trend inflection points. The Annual Percent Change (APC) was estimated for each trend.ResultsMortality rates per 100,000 person-years increased from 20.6 to 30.1 for men and 13.8 to 20.8 for women between 2000 and 2015. Men presented a relevant trend increase between 2008 and 2015 (APC [95% CI] 7.2% [5.3;9.2]) and women between 2008 and 2013 (7.9% [4.1;11.8]) There were no trend differences between sexes. For 65-74 years old men we found a relevant increase in the last period (2011-2015) (7.8% [1.0;15.1]). Those aged 75-84 years showed a trend increase between 2007 and 2015 (6.4% [4.4;8.4]) and men ≥85 years presented a remarkably high trend between 2008 and 2015 (9.0% [5.2;13]). There were no relevant differences between age groups. Women aged 65-74 had no relevant trend through the period. Those aged 75-84 presented an uniform trend increase for the whole period, 2000-2015, (3.4% [2.3;4.4]) and women ≥85 had and important trend increase between 2008 and 2013 (11.1% [5.3;17.2]), that has reached an stable level in the last 2 years. There were no relevant differences between the 75-84 and ≥85 age groups.ConclusionsRecent mortality trends from accidental falls increased in men ≥65 years and women ≥75 years. These results recommend the implementation of specific preventive programs.

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“…To analyse HF trend, the age/sex-adjusted average annual change in incidence (incidence rate ratio, IRR Furthermore, the relationship between age and mortality after a hip fracture in older adults may reach 5.5% and can be associated with several comorbidities, such as con-gestive heart failure, metastasis, fluid and electrolyte disorders, coagulation deficiencies, or liver disease. 4 Indeed, older adults who suffered hip fractures in a hospital may present a worse surgical (grade III and IV of the American Association of Anesthesiologists -ASA score) and mortality risk than those who suffered hip fractures in the community. 5 Medical treatments associated to hip fracture can comprise conservative or invasive procedures.…”

Section: Introductionmentioning

confidence: 99%

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

Jiménez-Mola

Calvo‐Lobo

Idoate-Gil

et al. 2018

Rev. Assoc. Med. Bras.

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SUMMARY BACKGROUND Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures. METHODS A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75–84, 85–90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed. RESULTS The age ranges did not show any statistically-significant differences (P<.05; R2=.000–.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R2=.011–.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson’s disease, aortic stenosis, surgery type, ASA–score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R2=.000–.010). CONCLUSION Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

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Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients

Abstract: The association between age and mortality after hip fracture remains after adjusting for numerous comorbidities. However, some potentially controllable disorders are associated with an increased risk for mortality, thus, improving their management could benefit survival.

Cited by 40 publications

References 33 publications

Liver disease and mortality among patients with hip fracture: a population-based cohort study

Liver disease and mortality among patients with hip fracture: a population-based cohort study

Mortality trends for accidental falls in older people in Spain, 2000-2015

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

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