Medical Treatment Predicts Mortality After Hip Fracture

Abstract

BackgroundThe mortality after hip fracture has remained high and stable the past 50 years despite improved surgical treatment. The aim of this study was to identify medications and medical factors associated with mortality after hip fracture.MethodsThis is a prospective observational study with median observation time of 21 months. Three hundred and sixty-four patients, mean age 83.4 years and 75.8% women, were enrolled. Information on comorbidity, medications, surgery, and clinical findings were collected at the time of fracture. Information on cause and time of death was obtained from the Norwegian Cause of Death Register.ResultsSix risk factors and one protective factor were identified by Cox proportional hazards model adjusted for propensity score: the use of diuretics (adjusted hazard ratio [HR] = 4.03, 95% confidence interval [CI] = 2.13–7.64), history of coronary heart disease (CHD) (HR = 2.61, CI = 1.37–4.98), male sex (HR = 2.32, CI = 1.27–4.24), Barthel Index ≤ 18/20 (HR = 2.48, CI = 1.23–5.01), heart rate > 100 on admission (HR = 2.47, CI = 1.18–5.14), body mass index ≤ 20 (HR = 1.94, CI = 1.13–3.34), and the use of statins (HR = 0.23, CI = 0.08–0.68). Patients using diuretics had increased risk of death from all causes, including death from CHD, chronic obstructive pulmonary disease, and falls or other accidents.ConclusionsThe use of diuretics is the strongest predictor of mortality, followed by CHD at the time of fracture, whereas the use of statins is associated with improved survival. Future research is needed to evaluate whether improved diagnosis and management of CHD and congestive heart failure among hip fracture patients would improve survival.

Functional capacity and risk factors in elderly trauma victims

“…Ninety days after hospital discharge, the independent factors were female gender with age ≥80 years and femoral neck fracture, which showed a 46 times greater chance of loss of functionality. These results are similar to the results of studies that have shown a predominance of elderly women, 70 or older, fall victims [1,2,[22][23][24][25][26][27], TBI [24,28] and associated comorbidities [25,29,30].…”

Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients

“…Advanced age, male gender, nursing home residency, use of diuretics and coronary heart disease have previously been identified as risk factors for increased mortality in patients admitted with hip fractures [14]. The association between hyponatraemia and medical co-morbidities, most notably congestive heart failure, liver cirrhosis and pneumonia is well established [15].…”

Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,210 patients

“…This group of patients may accordingly lack the reserve capacity often necessary to cope with a double trauma of hip fracture and surgery. Other studies have described comorbidity, age, male sex, delayed surgery and cognitive impairment as some of the most important risk factors for mortality [22][23][24][25][26]. Time from fracture to surgery is the only factor we can influence; our aim has been to identify other preventable factors that increase mortality risk.…”