Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study

Abstract

Objective:Multiple comorbidities in hip fracture patients are associated with increased mortality and complications. The goal of this study was to characterize the relationship between specific patient factors including comorbidities and outcomes in geriatric hip fractures, including length of stay, unplanned ICU admission, discharge disposition, complications, and mortality.Methods:This is a retrospective review of a trauma database from five Level 1 and Level 2 trauma centers of patients with hip fractures of the femoral neck and intertrochanteric region who underwent treatment using hip pinning, hemiarthroplasty, total hip arthroplasty, cephalomedullary nailing, or dynamic hip screw fixation. Mortality was the primary outcome variable (including in-hospital mortality, 30-day mortality, 60-day mortality, and 90-day mortality). Secondary outcome variables included in-hospital adverse events, unplanned transfer to the ICU, postoperative length of stay, and discharge disposition. Regression analyses were used for evaluation of relationships between comorbidities as independent variables and primary and secondary outcomes as dependent variables.Results:Two thousand three hundred patients were included. The mortality was 1.8%, 7.0%, 10.9%, and 14.1% for in-hospital, 30-day, 60-day, and 90-day mortality, respectively. Diabetes and cognitive impairment present on admission were associated with mortality at all-time intervals. COPD was the only comorbidity that signaled in-hospital adverse event with an odds ratio of 1.67 (P = 0.012). No patient factors, time to surgery, or comorbidities signaled unplanned ICU transfer. Patients with renal failure and COPD had longer hospital stays after surgery.Conclusion:Geriatric hip fractures continue to have high short-term morbidity and mortality. Identifying patients with increased odds of early mortality and adverse events can help teams optimize care and outcomes. Patients with diabetes, cognitive impairment, renal failure, and COPD may benefit from continued and improved medical optimization during the perioperative period as well as being more closely managed by a medicine team without delaying time to the operating room.

Influencing factors on morbidity and mortality in intertrochanteric fractures

“…In a systematic review and meta-analysis by Ma et al the rate of early mortality following intertrochanteric fracture was 15.1% 36 . The in-hospital mortality rate reported in the literature ranged from 1.2 to 1.8%, which is lower than the mortality rate of our study (3.23%) 8 , 37 , 38 . It is worth noting that our hospital is a referral center, and our patients mainly come from regions with poor economic and sanitary conditions.…”

Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study

“…However, a previous Australian study found that the most common type of hip fractures was at the neck of the femur (56%) and pertrochanteric (or intertrochanteric) fractures (38%) [ 7 ]. We did not investigate individual comorbidities, which may be associated with higher risk of mortality following hip fracture [ 48 , 49 ]. Future research on individual comorbidities is warranted.…”

Comparison of mortality rates and risk factors for mortality between proximal femoral nailing and bipolar hemiarthroplasty for hip fractures

“…In their multicenter study, McHugh et al 20 determined that diabetes and dementia affected mortality in all processes, while COPD was the only disease associated with in-hospital mortality. In a study of 911 deceased patients, Barcelo et al 21 found that 146 of them had CHF and 126 had dementia.…”