Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study

Abstract

Hip fracture (HF) remains a main issue in the elderly patient. About 1.6 million patients a year worldwide are victims of a Hf. their incidence is expected to rise with the aging of the world's population. identifying risk factors is mandatory in order to reduce mortality and morbidity. the aim of the study was to identify risk factors of 1-year mortality after HF surgery. We performed an observational, prospective, single-center study at Amiens University Hospital (Amiens, france). After ethical approval, we consecutively included all patients with a HF who underwent surgery between June 2016 and June 2017. Perioperative data were collected from medical charts and by interviews. Mortality rate at 12 months was recorded. Univariate analysis was performed and mortality risk factors were investigated using a Cox model. 309 patients were analyzed during this follow-up. Mortality at 1 year was 23.9%. Time to surgery over 48 hours involved 181 patients (58.6%) while 128 patients (41.4%) had surgery within the 48 hours following the hospital admission. Independent factors associated with 1-year mortality were: age (HR at 1.059 (95%CI [1.005-1.116], p = 0,032), Lee score ≥ 3 (HR at 1,52 (95% CI [1,052-2,198], p = 0.026) and time to surgery over 48 hours (HR of 1.057 (95% CI [1.007-1.108], p = 0.024). Age, delayed surgical (over 48 hours) management and medical history are important risk factors of 1-year mortality in this French cohort Hip fracture (HF) remains a main issue in the elderly patient. As bone loss tends to decreases in association with osteoporosis and osteopenia, the risk of hip fracture increases 1. HF represents a health care concern as the incidence and the mortality rate remains high 2,3. The world estimation of patients with HF is around 1.6 million a year 4. In France, 150 000 patients each year suffer HF. The mortality rate varies from 8 to 36% depending on the country 5-7. Only 50% patients will have independent living preservation following HF management 8. Recognized risk factors for HF are old age, reduced activity, female gender and osteoporosis. Though, in every day anesthesia practice, HF represents a surgery all practitioners have to deal with. However, data on perioperative management are lacking or rely on small sample size. Evidence is of low quality or even non-existent. Besides HF management mainly depends on each country healthcare system. Literature is abundant on national observational cohort 9,10. However, data are rarely comparable from one country to another depending on its healthcare system. Moreover, the management requires a multidisciplinary approach including geriatrician, surgeon and anesthetist. It seems that a care organization within a dedicated orthogeriatric ward can reduce long-term mortality 11-13. A recent meta-analysis revealed residential status, pulmonary disease, cardiovascular disease, diabetes, and time to surgery increased the risk of mortality after HF surgery 14. It also seems that surgery delay counts for the poor prognosis as reported in another meta-anal...

Rapid preoperative predicting tools for 1-year mortality and walking ability of Asian elderly femoral neck fracture patients who planned for hip arthroplasty

“…In the present study, the all-cause mortality 1 year after arthroplasty was 23.4%. Previous studies showed that 1-year mortality of hip fracture patients varied between 16.6 to 23.9% according to different study designs [ 14 , 15 ], which were consistent with ours. But we did admit that the 1-year mortality was a little higher in our study.…”

Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients – A Retrospective, Propensity-Score Matched Study

“…The retrospective studies in question enrolled patients with different types of hip fracture (femoral neck vs intertrochanteric fracture), surgery options (total hip arthroplasty, hemiarthroplasty, and internal fixation), and comorbidities between the PNB and non-PNB groups. Since mortality and other functional outcomes of elderly patients with hip fracture were affected by many patient-specific and treatment-related factors, 24 , 25 we believed that selection bias might be a plausible explanation for the conflicting results between previous studies and our own.…”

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

“…Over half had a surgical delay greater than 48 h (181 patients, 58.6%). Factors independently associated with 1-year mortality were: advanced age (HR = 1.06, 95%CI: 1.01–1.12; p =0.032), comorbidities as defined by the revised cardiac index or Lee score ≥ 3 (HR = 1,52, 95%CI: 1,05–2,20; p = 0.026) and surgical delay over 48 h (HR = 1.06, 95%CI = 1.01–1.11; p = 0.024) [ 140 ].…”