Postoperative Mortality after Hip Fracture Surgery: A 3 Years Follow Up

Abstract

Background and AimsTo determine mortality rates and predisposing factors in patients operated for a hip fracture in a 3-year follow-up period.MethodsThe study included patients who underwent primary surgery for a hip fracture.The inclusion criteria were traumatic, non-traumatic, osteoporotic and pathological hip fractures requiring surgery in all age groups and both genders. Patients with periprosthetic fractures or previous contralateral hip fracture surgery and patients who could not be contacted by telephone were excluded. At 36 months after surgery, evaluation was made using a structured telephone interview and a detailed examination of the hospital medical records, especially the documents written during anesthesia by the anesthesiologists and the documents written at the time of follow-up visits by the orthopaedic surgeons. A total of 124 cases were analyzed and 4 patients were excluded due to exclusion criteria. The collected data included demographics, type of fracture, co-morbidities, American Society of Anesthesiologists (ASA) scores, anesthesia techniques, operation type (intramedullary nailing or arthroplasty; cemented-noncemented), peroperative complications, refracture during the follow-up period, survival period and mortality causes.ResultsThe total 120 patients evaluated comprised 74 females(61.7%) and 46 males(38.3%) with a mean age of 76.9±12.8 years (range 23–95 years). The ASA scores were ASA I (0.8%), ASA II (21.7%), ASA III (53.3%) and ASA IV (24.2%). Mortality was seen in 44 patients (36.7%) and 76 patients (63.3%) survived during the 36-month follow-up period. Of the surviving patients, 59.1% were female and 40.9% were male.The survival period ranged between 1–1190 days. The cumulative mortality rate in the first, second and third years were 29.17%, 33.33% and 36.67% respectively. The factors associated with mortality were determined as increasing age, high ASA score, coronary artery disease, congestive heart failure, Alzheimer’s disease, Parkinson’s disease, malignancycementation and peroperative complications such as hypotension (p<0.05). Mortality was highest in the first month after fracture.ConclusionThe results of this study showed higher mortality rates in patients with high ASA scores due to associated co-morbidities such as congestive heart failure, malignancy and Alzheimer’s disease or Parkinson’s disease. The use of cemented prosthesis was also seen to significantly increase mortality whereas no effect was seen from the anesthesia technique used. Treatment of these patients with a multidiciplinary approach in an orthogeriatric ward is essential. There is a need for further studies concerning cemented vs. uncemented implant use and identification of the best anesthesia technique to decrease mortality rates in these patients.

Dementia and CSF‐biomarkers for Alzheimer's disease predict mortality after acute hip fracture

“…The highest impact of cognitive impairment was seen during the first three months. This observation confirms the results from other studies and may—at least partly—be explained by the rehabilitation difficulties in patients with cognitive impairment . We were surprised to find a 2‐3 times enhanced mortality in the subgroup with MCI (CDR:0.5), reflecting a level of cognitive impairment, which generally remains unnoticed in the social context.…”

Hypnotic depth and postoperative death: a Bayesian perspective and an Independent Discussion of a clinical trial

“…3 Independent Discussion: Reducing mortality in this population may prove challenging given the urgent nature of surgery and comorbidity-driven risk factors. 10,11 Surgical factors (e.g. bone cementation 11 ) could be further explored.…”

“…Comorbidity burden may be a significant driver of postoperative mortality after hip fracture, as demonstrated here and in prior investigations. 10,11 Commentary: In the Original Discussion, the investigators focus on reasons why the findings of the current study were different from a smaller previous study with a similar design done by the same team. 6 The Independent Discussant notes that while there has been little research examining whether depth of sedation affects outcomes after hip fracture surgery, several clinical trials and observational studies have investigated whether the outcomes are different after general anaesthesia vs regional anaesthesia.…”

One-Year Retrospective Evaluation of Hip Fracture Patients Aged More than 80 Years and Postoperatively Monitored in the Intensive Care Unit

“…Age and male sex (9) and general anesthesia and time before surgery (10) were suggested as the primary factors causing high mortality rates. However, some other studies have reported contrasting results (11)(12)(13).…”