Morbidity and Mortality Among Patients With Hip Fractures Surgically Repaired Within and After 48 Hours

Sircar, P.; Godkar, D.; Mahgerefteh, Shmuel; Chambers, Karinn; Niranjan, S.; Cucco, Robert A.

doi:10.1097/01.pap.0000249906.08602.a6

Cited by 65 publications

(49 citation statements)

References 14 publications

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“…The relationship between the timing of surgery and the subsequent mortality risk has been the subject of some debate. There is evidence to suggest that patients who undergo hip fracture stabilization surgery within 48 h of the fracture event are at a reduced risk of death compared with those whose surgery is delayed [68][69][70]. However, there may be a number of barriers to achieving such early surgery including the patient's health status.…”

Section: Discussionmentioning

confidence: 99%

Excess mortality following hip fracture: a systematic epidemiological review

et al. 2009

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This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlighting the need for interventions to reduce this risk.Patients experiencing hip fracture after low-impact trauma are at considerable risk for subsequent osteoporotic fractures and premature death. We conducted a systematic review of the literature to identify all studies that reported unadjusted and excess mortality rates for hip fracture. Although a lack of consistent study design precluded any formal meta-analysis or pooled analysis of the data, we have shown that hip fracture is associated with excess mortality (over and above mortality rates in nonhip fracture/community control populations) during the first year after fracture ranging from 8.4% to 36%. In the identified studies, individuals experienced an increased relative risk for mortality following hip fracture that was at least double that for the age-matched control population, became less pronounced with advancing age, was higher among men than women regardless of age, was highest in the days and weeks following the index fracture, and remained elevated for months and perhaps even years following the index fracture. These observations show that patients are at increased risk for premature death for many years after a fragility-related hip fracture and highlight the need to identify those patients who are candidates for interventions to reduce their risk.

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Section: Discussionmentioning

confidence: 99%

Excess mortality following hip fracture: a systematic epidemiological review

et al. 2009

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“…68 Other studies have not shown a decrease in mortality with surgery within 48 hours of admission, 69 but they have revealed decreased minor and major complication rates. 70,71 We believe that once the patient is medically optimized, he or she should be taken to surgery in an expeditious manner to prevent potential complication and possibly improve mortality. However, the literature remains mixed in support of this notion.…”

Section: Discussionmentioning

confidence: 99%

The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders

Schnell

Friedman

Mendelson

et al. 2010

Geriatr Orthop Surg Rehabil

370

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Comanagement of geriatric hip fracture patients with standardized protocols has been shown to improve short-term outcomes after surgery. A standardized, patient-centered, comanaged Hip Fracture Program for Elders is examined for 1-year mortality. Patients 60 years of age who were treated in the Hip Fracture Program for Elders were comanaged by orthopaedic surgeons and geriatricians. Data including age, place of origin, procedure, length of stay, 1-year mortality, Charlson score, and activities of daily living (ADLs) were retrospectively collected. A total of 758 patients 60 years of age with hip fractures between April 15, 2005, and March 1, 2009, were included. Their data were analyzed, and the Social Security Death Index and the hospital data system were searched for mortality data. Seventy-eight percent were female, with a mean age of 84.8 years. The mean Charlson score was 3. Fifty percent were admitted from an institutional setting. The overall 1-year mortality was 21.2%. Age (odds ratio [OR] ¼ 1.03, 95% confidence interval [CI] ¼ 1.00-1.05; P ¼ .02), male gender (OR ¼ 1.55, 95% CI ¼ 1.01-2.36; P ¼ .04), low Parker mobility score (OR ¼ 2.94, 95% CI ¼ 1.31-6.57; P ¼ .01), and a Charlson score of 4 or greater (OR ¼ 2.15, 95% CI ¼ 1.30-3.55; P ¼ .002) were predictive of 1-year mortality. ADL dependence was a borderline predictor, as was medium Parker mobility score. Prefracture residence and moderate comorbidity (Charlson score of 2-3) were not independently predictive of mortality at 1 year after adjusting for other characteristics. A comprehensive comanaged hip fracture program for elders not only improves the short-term outcomes but also demonstrates a low 1-year mortality rate, particularly in patients from nursing facilities.Keywords geriatric trauma, systems of care, fragility fractures, hip, fractures, mortality Hip fractures in older adults are a leading public health concern. The incidence of hip fractures has been declining over the past decade; however, the total number of fractures has grown exponentially. 1 The number of hip fractures in the United States could total 840 000 by the year 2040.2,3 Older adults are the fastest growing segment of the US population. The population aged 65 years and older is predicted to more than double by 2050, increasing from 39 million today to 89 million. 4 It has been estimated that 1 in 3 women and 1 in 12 men will sustain a hip fracture in their lifetime.5 It has been reported that 86% of hip fractures occur in individuals aged 65 years and older. Hip fractures are associated with significant morbidity, mortality, loss of independence, and financial burden. [6][7][8][9][10][11][12] In usual care, the reported 1-year mortality after sustaining a hip fracture has been estimated to be 14% to 58% (Table 1). 1,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The relative risk of mortality in the elderly patient population increases 4% per year. 30 The first year after a hip fracture appears to be the most critical time. A recent meta-ana...

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“…Lower mortality rates, fewer complications and decreased length of stay can thereby be obtained. 7,13,[17][18][19][20] …”

Section: Introductionmentioning

confidence: 99%