Mortality Rates of Patients with a Hip Fracture in a Southwestern District of Greece: Ten-Year Follow-Up with Reference to the Type of Fracture

Abstract

Increased mortality after a hip fracture has been associated with age, sex, and comorbidity. In order to estimate the long-term mortality with reference to hip fracture type, we followed 499 patients older than 60 years who had been treated surgically for a unilateral hip fracture for 10 years. At admission, patients with femoral neck fractures (n = 172) were 2 years younger than intertrochanteric patients (77.6 +/- 7.7 [SD] vs. 79.9 +/- 7.4 [SD], P = 0.001) and had a greater prevalence of heart failure (57% vs. 40.3%, P = 0.03). Similar mortality rates were observed at 1 year in both types of fracture (17.9% vs. 11.3%, log rank test P = 0.112). Mortality rates were significantly higher for intertrochanteric fractures at 5 years (48.8% vs. 34.7%, P = 0.01) and 10 years (76% vs. 58%, P = 0.001). Patients 60-69 years old with intertrochanteric fractures had significantly higher 10-year mortality than patients of similar age with femoral neck fractures (P = 0.008), while there was no difference between the groups aged 70-79 (P> 0.3) and 80-89 (P = 0.07). Women were less likely to die in 5 years (relative risk [RR] = 0.57, 95% confidence interval [CI] 0.41-0.79, P = 0.0007) and 10 years (RR = 0.65, 95% CI 0.49-0.85, P = 0.002). Age, sex, the type of fracture, and the presence of heart failure were independent predictors of 10-year mortality (Cox regression model P < 0.0001). The intertrochanteric type was independently associated with 1.37 (95% CI 1.03-1.83) times higher probability of death at 10 years (P = 0.002). In conclusion, the type of fracture is an independent predictor of long-term mortality in patients with hip fractures, and the intertrochanteric type yields worse prognosis.

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

“…A model was created evaluating the treatment of geriatric patients (an average age of 80 years was used for the base case [23,30,36,56]) with osteoporotic hip fractures using (1) admission to a traditional single service, (2) universal admission to a formally comanaged service with a specifically dedicated geriatric healthcare team (with resources in place to expedite time to the operating room), or (3) a risk-stratified model where patients who were high risk and sicker are assigned to a comanagement service, and patients who are healthier, with less-complex conditions were admitted to a lower-cost traditional service. Costs and clinical outcome probabilities were based on reported values [3,4,12,17,19,23,37,43,48].…”

“…In terms of postoperative mortality, we assumed a baseline 1-year mortality rate of 20% [12,23,30,36,56,57], with a 30% increase in mortality for patients with operative treatment delayed more than 48 hours, based on several meta-analyses [48,57,59]. The 95% CI of mortality increase was based on the broadest ranges given in these meta-analyses, and ranged from a 5% to a 49% increase.…”

“…The 95% CI of mortality increase was based on the broadest ranges given in these meta-analyses, and ranged from a 5% to a 49% increase. Life expectancy after the first year of surgery was assumed to be 8 years based on US actuarial tables [1,36]. Other than a direct mortality benefit from an earlier time to the operating room, we assumed the comanagement system had no other effects in overall mortality rate [24,28,61] ( Table 1).…”

A csípőtáji törések hazai ellátásának elemzése a 2004–2009 közötti időszakban

“…Ausztrál, svéd, görög, amerikai kutatások szerint az egy éven belüli halálozás megközelíti a 30%ot (21-27%). A tanulmányok szerint jellemző a férfiak magasabb halá lozása [6][7][8][9][10]. A csípőtáji törésen átesett betegek halálo zási aránya háromszor magasabb a hasonló korcsoportú normálpopulációhoz képest [11,12].…”

“…Mind a 4 hóna pos, mind pedig az egyéves halálozási arány hazánkban jóval meghaladta a fejlett egészségügyi kultúrával rendel kező nyugateurópai országok átlagát, de elmaradt a volt szocialista (például Litvánia) és kevésbé fejlett nyugat európai országok (például Görögország) adataitól is [9,20].…”