Gender and Race/Ethnicity Differences in Hip Fracture Incidence, Morbidity, Mortality, and Function

Sterling, Robert S.

doi:10.1007/s11999-010-1736-3

Cited by 195 publications

(177 citation statements)

References 27 publications

(48 reference statements)

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“…Also, how did the comorbidity profiles differ between the two sexes? Overall, the study results corroborate trends in short-term adverse events seen after other surgical procedures, such cardiac or hip fracture surgery-with men having a higher comorbidity burden and poorer outcomes [3,4].…”

supporting

confidence: 71%

CORR Insights®: Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Pugely

2015

Clinical Orthopaedics &Amp; Related Research

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supporting

confidence: 71%

CORR Insights®: Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Pugely

2015

Clinical Orthopaedics &Amp; Related Research

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“…Nursing home patients are in general sicker than community dwellers and the higher burden of comorbidities in men compared to women has been previously described. 19 Two published reports of the model of care in this study have shown lower TTS, LOS, and complication rate when compared to usual or standard care. 12,20 This study shows that the comorbidity burden of the patients did not affect either their TTS or their LOS.…”

Section: Discussionmentioning

confidence: 49%

The Impact of Comorbidity on Perioperative Outcomes of Hip Fractures in a Geriatric Fracture Model

Menzies

Mendelson

Kates

et al. 2012

Geriatr Orthop Surg Rehabil

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Background: Older adults who sustain hip fractures usually have multiple coexisting medical problems that may impact their treatment and outcomes. The geriatric fracture center (GFC) provides a model of care that standardizes treatment and optimizes outcomes. The purpose of this study is to determine whether GFC patients with a higher burden of comorbidity or specific comorbidities are at risk for worsened perioperative outcomes, such as increased time to surgery (TTS), postoperative complications, and longer length of hospital stay (LOS). Method: A total of 1077 patients aged 60 years and older who underwent surgery for a proximal femur fracture between April 15, 2005, and September 30, 2010, were evaluated. Comorbidities measured in the Charlson Comorbidity index were abstracted through chart review. Outcomes were TTS, postoperative complications, and LOS. Results: Most patients were white, with an average age of 85. One half lived in either a nursing home or an assisted living facility. The mean Charlson score was 3.06 and the nursing home residents had a significantly higher score compared to community dwellers (3.4 vs 2.8; P < .0001). Dementia was the most common comorbidity. There was no difference in the LOS or TTS based on Charlson score. The overall complication rate was 44% with delirium being the most common postoperative complication. Peripheral vascular disease, history of solid tumor, and peptic ulcer disease predicted delirium incidence. Charlson score predicted complication risk, with an odds ratio of 1.12 for each point increase. Conclusion: Frailty and comorbidity put this hip fracture population at high risk for adverse perioperative outcomes. This study shows that in the GFC model of care the comorbidity burden did not impact the TTS and LOS but did predict postoperative complication rate.

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“…However, it is unclear whether arthroplasty leads to better function, lower reoperation rate, and fewer complications in the long term [11]. Although there are some studies at longer term [20], including reporting results into the second decade [15], these series did not find differences between internal fixation and arthroplasty in terms of mortality. However, a meta-analysis might allow pooling of the data, which could increase the likelihood that smaller but potentially important clinical differences could be detected between treatments than is possible in individual trials.…”

Section: Introductionmentioning

confidence: 94%

“…Hip fractures often are related to osteoporosis in older patients [20]. Every year, approximately 1.6 million people worldwide sustain hip fractures.…”

Section: Introductionmentioning

confidence: 99%

Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

Jiang

Yang

Lin

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation. Questions/purposes We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup.Methods Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science TM were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I 2 ) and publication bias was assessed using forest plots. Results There were no differences between the internal fixation and arthroplasty groups for patient mortality at midterm (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06-0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06-0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02-1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, À0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32-14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40-2.01; p = 0.78) between patients treated with arthroplasty and internal fixation. Conclusions Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid-and long-term followup, and better mid-term functional recovery. Future

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Gender and Race/Ethnicity Differences in Hip Fracture Incidence, Morbidity, Mortality, and Function

Cited by 195 publications

References 27 publications

CORR Insights®: Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

CORR Insights®: Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

The Impact of Comorbidity on Perioperative Outcomes of Hip Fractures in a Geriatric Fracture Model

Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

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