Predictors of early mortality after hip fracture surgery

Abstract

Purpose The aim of this study was to examine causes and potential risk factors for 30-day mortality after hip fracture surgery (HFS) at a high-volume tertiary-care hospital. Methods We retrospectively reviewed 467 patients who underwent HFS at our institution. Multivariate analysis was undertaken to identify potential predictors of early mortality. Results The 30-day mortality rate was 7.5 % (35/467). The most common causes of death were pneumonia (37.1 %, 13/ 35), acute coronary syndrome (31.4 %, 11/35) and sepsis (14.3 %, 5/35). Surgery after 48 hours of admission had a significantly higher 30-day mortality rate (11 % versus 4 %, p =0.006). There was a significant difference in age (p =0.034), admission source (p <0.001), preoperative haemoglobin (p < 0.001), walking ability (p =0.004), number of comorbidities (p =0.004) and pre-existing dementia (p =0.01), cardiac disease (p <0.001), chronic obstructive pulmonary disorder (COPD) (p =0.036) and renal failure (p =0.007) between the 30-day mortality group and the rest of the cohort. Surgical delay greater than 48 hours, admission source and preexisting cardiac disease were identified as the strongest predictors of 30-day mortality. Conclusion Surgical delay is an important but avoidable determinant of early mortality after HFS. Respiratory and cardiac function needs to be optimised postoperatively with early intervention in patients with signs of cardiovascular compromise or infection.

The effect of becoming a major trauma centre on outcomes for elderly hip fracture patients

“…As previous studies have reported, delay to surgery is likely to be influential in increased early mortality rates [7][8][9][10]. In this study, the rise in 30 day mortality rate from 4.7% pre-MTC to 8.0% post-MTC may therefore be due to increased delays to surgery and consequent increased post-operative complications in the post-MTC group.…”

“…The mortality rate according to the most recent NHFD report is 8.2% at 30 days [5], further highlighting the frailty of this patient population and the need for medical optimisation peri-operatively. Delays to surgery have been shown to increase post-operative complications [6], and several studies have also shown a consequent increase in mortality rates [7][8][9]. A systematic review studying the timing of hip fracture surgery in over 250,000 patients concluded that early surgery reduces hospital stay, and is likely to reduce complications and mortality [10].…”

Advanced Age, High β-CTX Levels, and Impaired Renal Function are Independent Risk Factors for All-Cause One-Year Mortality in Hip Fracture Patients

“…Cardiovascular diseases are the most common causes of death among patients with hip fractures [11,[40][41][42]. A study by Wu et al could explain why elevated levels of b-CTX were associated with increased mortality in our patients [43].…”

Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures

“…It is scarcely surprising that differing severity levels of dementia are observed in 22-54% of patients with hip fractures [12,13,14,15,16]. It must be assumed that patients with hip fracture and preexisting cognitive impairment are at an even higher risk for poor postoperative outcomes compared with mentally healthy patients because of their preexisting mental and physical impairments.…”