Effect of dementia on all-cause mortality in hip fracture surgery: a retrospective study on a nationwide Korean cohort

Jeong, Sung Hoon; Lee, Hyeon Ji; Kim, Seung Hoon; Park, Sohee

doi:10.1136/bmjopen-2022-069579

Cited by 3 publications

(3 citation statements)

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“…Specifically, Bai et al found that mortality of dementia patients with hip fractures postoperatively is 12% at 30day follow-up and 45% at more than 1year follow-up 27 . Similarly, other studies show that hip fracture patients with dementia have an increase in mortality rate between 23% and 67% 21,22,26 .…”

Section: Morbidity and Mortality Of Hipmentioning

confidence: 59%

“…When analyzing the number of hip fracture patients who had a preincident diagnosis of dementia, studies suggest that between 10.5% and 29.7% of patients who undergo hip fracture surgery have a preoperative diagnosis of dementia 12,[22][23][24] . These studies, however, only included patients who underwent surgery to repair a hip fracture.…”

Section: Morbidity and Mortality Of Hipmentioning

confidence: 99%

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Dementia and Hip Fractures

Zabawa,

Choubey,

Drake

et al. 2023

JBJS Reviews

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» The elderly population is the fastest growing demographic, and the number of dementia cases in the United States is expected to double to 10 million by 2050.» Patients with dementia are at 3× higher risk of hip fractures and have higher morbidity and mortality after hip fractures.» Hip fracture patients with dementia benefit from early analgesia and timely surgical fixation of fracture.» Early and intensive inpatient rehabilitation is associated with improved postoperative outcomes in patients with dementia.» Coordination of care within a “orthogeriatric” team decreases mortality, and fracture liaison services show potential for improving long-term outcomes in hip fracture patients with dementia.

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Section: Morbidity and Mortality Of Hipmentioning

confidence: 59%

Section: Morbidity and Mortality Of Hipmentioning

confidence: 99%

Dementia and Hip Fractures

Zabawa,

Choubey,

Drake

et al. 2023

JBJS Reviews

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“…Hip fracture among older adults often results in decreased independence and quality of life . Surgery is a potential treatment option, yet people living with dementia undergoing this operation experience higher mortality, delirium, and postoperative complications, with a consequent greater loss of mobility compared with persons without cognitive difficulties . Much less is known about what happens to patients with hip fractures who do not have surgery.…”

Section: Introductionmentioning

confidence: 99%

Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living With Dementia

Adler,

Xiang,

Shah

et al. 2024

JAMA Netw Open

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ImportanceThe decision for surgical vs nonsurgical treatment for hip fracture can be complicated among community-dwelling people living with dementia.ObjectiveTo compare outcomes of community-dwelling people living with dementia treated surgically and nonsurgically for hip fracture.Design, Setting, and ParticipantsThis retrospective cross-sectional study undertook a population-based analysis of national Medicare fee-for-service data. Participants included community-dwelling Medicare beneficiaries with dementia and an inpatient claim for hip fracture from January 1, 2017, to June 30, 2018. Analyses were conducted from November 10, 2022, to October 17, 2023.ExposureSurgical vs nonsurgical treatment for hip fracture.Main Outcomes and MeasuresThe primary outcome was mortality within 30, 90, and 180 days. Secondary outcomes consisted of selected post–acute care services.ResultsOf 56 209 patients identified with hip fracture (73.0% women; mean [SD] age, 86.4 [7.0] years), 33 142 (59.0%) were treated surgically and 23 067 (41.0%) were treated nonsurgically. Among patients treated surgically, 73.3% had a fracture of the femoral head and neck and 40.2% had moderate to severe dementia (MSD). Among patients with MSD and femoral head and neck fracture, 180-day mortality was 31.8% (surgical treatment) vs 45.7% (nonsurgical treatment). For patients with MSD treated surgically vs nonsurgically, the unadjusted odds ratio (OR) of 180-day mortality was 0.56 (95% CI, 0.49-0.62; P &lt; .001) and the adjusted OR was 0.59 (95% CI, 0.53-0.66; P &lt; .001). Among patients with mild dementia and femoral head and neck fracture, 180-day mortality was 26.5% (surgical treatment) vs 34.9% (nonsurgical treatment). For patients with mild dementia who were treated surgically vs nonsurgically for femoral head and neck fracture, the unadjusted OR of 180-day mortality was 0.67 (95% CI, 0.60-0.76; P &lt; .001) and the adjusted OR was 0.71 (95% CI, 0.63-0.79; P &lt; .001). For patients with femoral head and neck fracture, there was no difference in admission to a nursing home within 180 days when treated surgically vs nonsurgically.Conclusions and RelevanceIn this cohort study of community-dwelling patients with dementia and fracture of the femoral head and neck, patients with MSD and mild dementia treated surgically experienced lower odds of death compared with patients treated nonsurgically. Although avoiding nursing home admission is important to persons living with dementia, being treated surgically for hip fracture did not necessarily confer a benefit in that regard. These data can help inform discussions around values and goals with patients and caregivers when determining the optimal treatment approach.

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