Perioperative risk factors in patients with a femoral neck fracture – influence of 25-hydroxyvitamin D and C-reactive protein on postoperative medical complications and 1-year mortality

Abstract

BackgroundThis study examined the association of 25-hydroxyvitamin D (25(OH)D) and C-reactive protein (CRP) with postoperative medical complications and one year mortality of elderly patients sustaining a low-energy cervical hip fracture scheduled for surgery. We hypothesized that vitamin D deficiency and CRP in these patients might be associated with an increased 1-year mortality.MethodsThe prospective single-center cohort study included 209 patients with a low-energy medial femoral neck fracture; 164 women aged over 50 years and 45 men aged over 60 years. Referring to 1-year mortality and postoperative medical complications multiple logistic regression analysis including 10 co-variables (age, sex, BMI, ASA, creatinine, CRP, leukocytes hemoglobin, 25(OH)D, vitamin D supplementation at follow-up) was performed.ResultsVitamin D deficiency was prevalent in 87 % of all patients. In patients with severe (<10 ng/ml) and moderate (10–20 ng/ml) vitamin D deficiency one year mortality was 29 % and 13 %, respectively, compared to 9 % in patients with > 20 ng/ml 25(OH)D levels (p =0.027). Patients with a mild (CRP 10–39.9 mg/l) or active inflammatory response (CRP ≥ 40 mg/l) showed a higher one year mortality of 33 % and 40 % compared to 16 % in patients with no (CRP < 10 mg/l) inflammatory response (p = 0.002). Multiple logistic regression analysis identified CRP (OR 1.01, 95 % CI 1.00-1.02; p = 0.007), but not 25(OH)D (OR 0.97, 95 % CI 0.89-1.05; p = 0.425) as an independent predictor for one year mortality. 20 % of patients suffered in-hospital postoperative medical complications (i.e. pneumonia, thromboembolic events, etc.). 25(OH)D (OR 0.89, 95 % CI 0.81–0.97; p = 0.010), but not CRP (OR 1.01, 95 % CI 1.00-1.02; p = 0.139), was identified as an independent risk factor.ConclusionIn elderly patients with low-energy cervical hip fracture, 25(OH)D is independently associated with postoperative medical complications and CRP is an independent predictor of one year mortality.

Influence of Internal Fixation and Cemented Hemiarthroplasty on 1-Year Mortality in Geriatric Hip Fracture Patients

“…Moreover, some laboratory parameters differed considerably between groups. Higher mortality rates after hip fracture were identified in patients with low hemoglobin, high leucocyte count, creatinine levels [6] or high CRP [7] . A potential effect of 25(OH)D levels on mortality is discussed controversially [22,23] .…”

“…Others identified severe vitamin D deficiency as a significant predictor of 1-year mortality after femoral neck fracture in elderly patients. However, an independent association was not shown, potentially due to a limited number of patients [7] . A delay in surgery of hip fracture patients might be an indicator for the need of more intense preoperative diagnostic work-up and conditioning of patients with acute illness or deterioration of chronic disease.…”

“…At 12 months mortality rates were 14.5% and 13.4%, respectively [27] . However, stratifying treatment to severity of hip fractures may be associated with considerable bias, since a higher degree of fracture displacement is significantly associated with hypovitaminosis D [28] which in turn may affect morbidity and mortality in these patients [7] . Only one retrospective study found a higher cumulative mortality after internal fixation compared to HA [29] .…”

“…Moreover, several laboratory parameters such as haemoglobin, albumin, creatinine, c-reactive protein (CRP) and 25-hydroxyvitamin D (25(OH)D) were found to be associated with an increased mortality after hip fracture [5][6][7] . In contrary, the influence of the surgical management in this regard seems to be of minor importance.…”

Vitamin D Status, Estradiol and Bone Metabolism in Elderly Female Patients With Hip Fracture

“…Hip fractures are considered as the most severe osteoporotic fractures associated with high morbidity and mortality [1][2][3] . Fracture toughness in elderly patients depends not only on bone mineral density, but also on different aspects of bone quality.…”