Inverse relation of body weight with short-term and long-term mortality following hip fracture surgery: a meta-analysis

Yang, Tzu-I; Chen, Yuhang; Chiang, Ming-Chou; Kuo, Yi-Jie; Chen, Yu‐Pin

doi:10.1186/s13018-022-03131-3

Cited by 6 publications

(5 citation statements)

References 57 publications

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“…In a large surgical cohort [ 27 ], the perioperative mortality rate was higher in patients with a BMI <25 kg/m 2 compared with those who had a BMI ≥ 25 kg/m 2 . In line with previous reports and our findings, patients who were overweight/obese were associated with a lower risk of mortality after orthopedic surgery [ 28 ], particularly in the elderly [ 29 , 30 ]. People who underwent a vertebroplasty for vertebral fractures were commonly older than 65 years of age [ 8 , 9 , 10 , 31 , 32 ].…”

Section: Discussionsupporting

confidence: 93%

Association of Body Mass Index with Long-Term All-Cause Mortality in Patients Who Had Undergone a Vertebroplasty for a Vertebral Compression Fracture

Wang

Lin

et al. 2022

JCM

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We aimed to investigate the association between preoperative body mass index (BMI) and postoperative long-term mortality in patients who underwent a vertebroplasty. We retrospectively enrolled patients with a vertebral compression fracture who underwent a vertebroplasty between May 2013 and June 2020 in a medical center in Taiwan. The survival status of the study sample was confirmed by the end of March 2021. Cox-proportional hazard models were conducted to examine the effects of being overweight/obese (≥25 kg/m2 vs. <25 kg/m2) and BMI (as a continuous variable) on all-cause mortality after adjusting for age, sex, history of smoking, diabetes, hypertension, chronic kidney disease, and osteoporosis. A total of 164 patients were analyzed (mean age 75.8 ± 9.3 years, male 25.6%, mean BMI 24.0 ± 4.1 kg/m2) after a median follow-up of 785 days. Compared with a BMI < 25 kg/m2, a BMI ≥ 25 kg/m2 was associated with a significantly lower risk of all-cause mortality (HR 0.297, 95% CI 0.101 to 0.878, p = 0.028). These findings were consistent when BMI was examined as a continuous variable (HR 0.874, 95% CI 0.773 to 0.988, p = 0.031). A low BMI (<22 kg/m2) should be considered as a risk factor for postoperative long-term mortality in this ageing population.

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Section: Discussionsupporting

confidence: 93%

Association of Body Mass Index with Long-Term All-Cause Mortality in Patients Who Had Undergone a Vertebroplasty for a Vertebral Compression Fracture

Wang

Lin

et al. 2022

JCM

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“…A meta-analysis including eight prospective studies concluded that weight change deeply impacts on the prognosis of patients with hip fracture; body weight loss and gain might be a risk and protective factor for hip fracture, respectively 25. Another meta-analysis including 11 independent studies concluded that obese patients following hip fracture surgery had lower mortality both in the long term and short term 26. This inverse relationship between body weight and mortality is known as the obesity paradox 27.…”

Section: Discussionmentioning

confidence: 99%

“…25 Another meta-analysis including 11 independent studies concluded that obese patients following hip fracture surgery had lower mortality both in the long term and short term. 26 This inverse relationship between body Open access weight and mortality is known as the obesity paradox. 27 Similar conclusions were reached in this study, but height data were severely missing, and only weight was included in the analysis; the lower the weight, the worse the prognosis of the patient.…”

Section: Open Accessmentioning

confidence: 99%

Development and validation of a novel nomogram of 1-year mortality in the elderly with hip fracture: a study of the MIMIC-III database

et al. 2023

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ObjectiveHip fracture is a prevalent condition with a significant death rate among the elderly. We sought to develop a nomogram-based survival prediction model for older patients with hip fracture.DesignA retrospective case–control study.SettingThe data from Medical Information Mart for Intensive Care III (MIMIC-III V.1.4).ParticipantsThe clinical features of elderly patients with hip fracture, including basic information, comorbidities, severity score, laboratory tests and therapy, were filtered out based on the MIMIC-III V.1.4.Methods and main outcome measuresAll patients included in the study were from critical care and randomly divided into training and validation sets (7:3). On the basis of retrieved data, the least absolute shrinkage and selection operator (LASSO) regression and multiple logistic regression analysis were used to identify independent predictive variables of 1-year mortality, and then constructed a risk prediction nomogram. The predictive values of the nomogram model were evaluated by the concordance indexes (C-indexes), receiver operating characteristic curve, decision curve analysis (DCA) and calibration curve.ResultsA total of 341 elderly patients with hip fracture were included in this study; 121 cases died within 1 year. After LASSO regression and multiple logistic regression analysis, a novel nomogram contained the predictive variables of age, weight, the proportion of lymphocyte count, liver disease, malignant tumour and congestive heart failure. The constructed model proved satisfactory discrimination with C-indexes of 0.738 (95% CI 0.674 to 0.802) in the training set and 0.713 (95% CI 0.608 to 0.819) in the validation set. The calibration curve shows a good degree of fitting between the predicted and observed probabilities and the DCA confirms the model’s clinical practicability.ConclusionsThe novel prediction model provides personalised predictions for 1-year mortality in elderly patients with hip fractures. Compared with other hip fracture models, our nomogram is particularly suitable for predicting long-term mortality in critical patients.

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“…It has been shown that a BMI below 20 kg/m 2 is associated with a higher mortality rate compared to normal weight [17,25]. A meta-analysis, including 11 studies, recently demonstrated an inverse relation of body weight with short-term and long-term mortality after hip fracture surgery [26]. Our data did not reveal any significant differences in the mortality rates related to the BMI, but there was a tendency towards a higher mortality rate in the underweight group (BMI < 20 kg/m 2 ) group.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Malnutrition Measured by Hypalbuminemia and Body Mass Index on the Outcome of Geriatric Patients with a Fracture of the Proximal Femur

et al. 2022

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Background and Objectives: Fractures of the proximal femur are a life-changing and life-threatening event for older people. Concomitant malnutrition has been described as an independent risk factor for complications and mortality. Therefore, we examined the influence of albumin and body mass index (BMI) as parameters for the nutritional state on the outcome after geriatric hip fracture surgery. Materials and Methods: Data were retrospectively collected from hospital information systems, and complications and all other parameters were obtained from patient charts. We included patients aged 70 years or above with a fracture of the proximal femur. We excluded periprosthetic and peri-implant fractures and patients with a missing BMI or albumin value. Results: Patients with a BMI below 20 kg/m2 were more likely to be female but did not differ from the normal BMI group in terms of baseline parameters. Patients with hypoalbuminemia had a higher ASA grade and Charlson Comorbidity Index, as well as a lower hemoglobin value and prothrombin time compared to those with normal albumin values and low BMI. Hypoalbuminemia was associated with significantly increased rates of complications (57.9% vs. 46.7%, p = 0.04) and mortality (10.3% vs. 4.1%, p = 0.02). Blood loss and transfusion rates were higher in the hypoalbuminemia group. Patients with a BMI below 20 kg/m2 had a higher risk of intraoperative cardiac arrest (2.6% vs. 0.4%, p = 0.05) but did not show higher mortality rates than patients with a BMI above 20 kg/m2. However, the outcome parameter could not be confirmed in the regression analysis. Conclusions: Hypoalbuminemia might be an indicator for more vulnerable patients with a compromised hemoglobin value, prothrombin time, and ASA grade. Therefore, it is also associated with higher mortality and postoperative complications. However, hypoalbuminemia was not an independent predictor for mortality or postoperative complications, but low albumin values were associated with a higher CCI and ASA grade than in patients with a BMI below 20 kg/m2.

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Inverse relation of body weight with short-term and long-term mortality following hip fracture surgery: a meta-analysis

Cited by 6 publications

References 57 publications

Association of Body Mass Index with Long-Term All-Cause Mortality in Patients Who Had Undergone a Vertebroplasty for a Vertebral Compression Fracture

Association of Body Mass Index with Long-Term All-Cause Mortality in Patients Who Had Undergone a Vertebroplasty for a Vertebral Compression Fracture

Development and validation of a novel nomogram of 1-year mortality in the elderly with hip fracture: a study of the MIMIC-III database

The Influence of Malnutrition Measured by Hypalbuminemia and Body Mass Index on the Outcome of Geriatric Patients with a Fracture of the Proximal Femur

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