Postoperative mortality after a hip fracture over a 15-year period in Denmark: a national register study

Gundel, Ossian; Thygesen, Lau Caspar; Gögenur, Ismail; Ekeloef, Sarah

doi:10.1080/17453674.2019.1680485

Cited by 65 publications

(119 citation statements)

References 22 publications

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“…These results mirror the current study where the overall 30-and 90-day post-operative mortality rates were 8.2% and 14.5%, respectively. Gundel et al [2] also demonstrated that male sex, increasing age and comorbidities were significant risk factors for 90-day post-operative mortality in hip fracture patients, an association that is in line with earlier studies [2,[17][18][19][20]. This remained true for our cohorts where these same variables were associated with an increased incidence of post-operative mortality.…”

Section: Discussionsupporting

confidence: 91%

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

Forssten

Ismail

Sjölin

et al. 2020

Eur J Trauma Emerg Surg

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Purpose The post-operative mortality after hip fracture surgery is high and has remained largely unchanged during the last decades. The Revised Cardiac Risk Index (RCRI) is a tool used to evaluate the 30-day risk of, among other outcomes, post-operative mortality. The aim of this study is to determine the association between the RCRI score and post-operative mortality in patients undergoing hip fracture surgery. Methods Data was obtained from the national hip fracture register which was cross-referenced with patients’ electronic hospital records. All adults who underwent primary emergency hip fracture surgery in Orebro County, Sweden, between January 1, 2013 and December 31, 2017, were included. Patients were divided into two cohorts: low RCRI (score = 0–1) and high RCRI (score ≥ 2). A Poisson regression model was employed to investigate the association between a high RCRI score and 30- and 90-day post-operative mortality. Results A total of 2443 patients, of whom 446 (18%) had a high RCRI score, were included in the current study. When adjusting for age, sex, comorbidities and type of surgery, the incidence of 30-day mortality increased by 46% in the high RCRI cohort (adj. IRR 1.46, 95% CI, 1.10–1.94, p = 0.010). Similar results were observed for 90-day mortality (adj. IRR 1.50, 95% CI, 1.21–1.84, p < 0.001). Conclusion The RCRI is applicable to patients that undergo surgery for traumatic hip fractures. A high RCRI score is associated with an increased incidence of both 30- and 90-day post-operative mortality. Future studies to evaluate these findings are needed.

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Section: Discussionsupporting

confidence: 91%

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

Forssten

Ismail

Sjölin

et al. 2020

Eur J Trauma Emerg Surg

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“… 19 Several studies show that adverse cardiovascular events are a common cause of death in patients undergoing surgery for hip fractures. 2 20 21 In cardiac surgery, there is strong evidence (level 1a) for the protective effects of β-blockade with a decreased risk of postoperative complications and higher degree of survival. 6 According to universal guidelines set by the American Heart Association/American College of Cardiology and European Society of Cardiology, BB therapy should not be discontinued before or after either cardiac or non-cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 1 The majority of hip fractures are treated surgically, as opposed to conservatively, and are associated with high postoperative mortality. The risk of early postoperative mortality ranges from 10% to 16%, 2 and is as high as 27% in the first postsurgical year. 2–4 Despite new improved innovations in orthopedic surgery and multidisciplinary team approaches to decision-making, postoperative mortality numbers after surgery for hip fractures have remained unchanged during the last decade.…”

Section: Introductionmentioning

confidence: 99%

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β-adrenergic blockade is associated with a reduced risk of 90-day mortality after surgery for hip fractures

Ismail

Borg

Sjölin

et al. 2020

Trauma Surg Acute Care Open

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BackgroundThere is a significant postoperative mortality risk in patients subjected to surgery for hip fractures. Adrenergic hyperactivity induced by trauma and subsequent surgery is thought to be an important contributor. By downregulating the effect of circulating catecholamines the increased risk of postoperative mortality may be reduced. The aim of the current study is to assess the association between regular β-blocker therapy and postoperative mortality.MethodsThis cohort study used the prospectively collected Swedish National Quality Registry for hip fractures to identify all patients over 40 years of age subjected to surgery for hip fractures between 2013 and 2017 in Örebro County, Sweden. Patients with ongoing β-blocker therapy at the time of surgery were allocated to the β-blocker-positive cohort. The primary outcome of interest was 90-day postoperative mortality. Risk factors for 90-day mortality were evaluated using Poisson regression analysis.ResultsA total of 2443 patients were included in this cohort of whom 900 (36.8%) had ongoing β-blocker therapy before surgery. The β-blocker positive group was significantly older, less fit for surgery based on their American Society of Anesthesiologists classification and had a higher prevalence of comorbidities. A significant risk reduction in 90-day mortality was detected in patients receiving β-blockers (adjusted incidence rate ratio=0.82, 95% CI 0.68 to 0.98, p=0.03).Conclusionsβ-blocker therapy is associated with a significant reduction in 90-day postoperative mortality after hip fracture surgery. Further investigation into this finding is warranted.Level of evidenceTherapeutic study, level III; prognostic study, level II.

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“…In-hospital management of fracture-related and cytokine-induced musculoskeletal pain in COVID-19 patients should take into account the recent warnings about the use of common NSAIDs in case of SARS-CoV-2 infection [ 18 – 20 ]. Nevertheless, the mortality after proximal femur fractures remains high, especially during the first year after the fracture, and COVID-19 needs a very long time for viral clearance [ 21 , 22 ]. The contribution of surgery to improve respiratory and laboratory values in COVID-19 patients with femur fractures should be verified by further studies with a longer follow-up and with control groups.…”

mentioning

confidence: 99%

COVID-19: not a contraindication for surgery in patients with proximal femur fragility fractures

et al. 2020

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Postoperative mortality after a hip fracture over a 15-year period in Denmark: a national register study

Cited by 65 publications

References 22 publications

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery

β-adrenergic blockade is associated with a reduced risk of 90-day mortality after surgery for hip fractures

COVID-19: not a contraindication for surgery in patients with proximal femur fragility fractures

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