Risk factors for in-hospital post-hip fracture mortality

Frost, Steven A.; Nguyen, Nguyen D.; Black, Deborah; Eisman, John A.; Nguyen, Tuan V.

doi:10.1016/j.bone.2011.06.002

Cited by 114 publications

(90 citation statements)

References 40 publications

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“…44 Delayed time to surgical fixation for hip fractures increases morbidity and mortality and decreases future function. 15,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]46 Our study confirmed this. Increasing time to surgery led to an increasing number of complications (P ¼ .0492) and a trend toward higher mortality (P ¼ .091).…”

Section: Discussionsupporting

confidence: 87%

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Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

Switzer

Bennett

Wright

et al. 2013

Geriatr Orthop Surg Rehabil

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Background: Due to the need for medical optimization and congested operating room schedules, surgical repair is often performed at night. Studies have shown that work done at night increases complications. The primary aim of our study is to compare the rates of complications and 30-day mortality between 2 surgical times of day, daytime group (DTG, 07:00-15:59) and nighttime group (NTG,. Methods: Retrospective chart review from 2005 through 2010. Setting: Level 1 Trauma Center. Participants: 1443 patients with hip fracture, age 50 years with isolated injury and surgical treatment of the fracture. Main Outcomes and Measures: Thirty-day mortality and complications: myocardial infarction, cardiac event, stroke, central nervous system event, pneumonia, urinary tract infection, postoperative wound infection, and bleeding requiring transfusion of 3 or more red blood cell units. Results: A total of 859 patients met the inclusion criteria; 668 patients in the DTG and 191 patients in the NTG. The 30-day mortality was 7.8%. The complication rate was 28%. No difference was found in 30-day mortality or complication rate based on the time of day the surgery was performed (P ¼ 1.0 and P ¼ .92, respectively). This remained unchanged when controlling for health status and surgical complexity. Age (odds ratio ¼ 1.03/year), Charlson Comorbidity Index (CCI; odds ratio ¼ 1.21), and American Society of Anesthesiologists (ASA; odds ratio ¼ 1.85) score were predictive of adverse outcomes. Conclusion: Surgical time of day did not affect 30-day mortality or total number of complications. Age, ASA score, and CCI were associated with adverse outcomes.

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Section: Discussionsupporting

confidence: 87%

“…[6][7][8][9][10][11][12][13][14][15] Poor outcomes may be predicted by patient comorbidities, surgical timing, and surgical volume. 7,[15][16][17][18][19][20][21][22][23][24][25][26][27] The effect of surgical time of day on hip fracture outcome is less clear.…”

Section: Introductionmentioning

confidence: 99%

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

Switzer

Bennett

Wright

et al. 2013

Geriatr Orthop Surg Rehabil

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“…10,11 The mortality rate is approximately 10% over the first month, and one-third with the first year. 8,[12][13][14] However, the fracture is directly attributable as the cause of death in less than 50% of cases, with other common causes including bronchopneumonia, heart failure, poor nutrition, stroke and secondary infection. 15,16 As part of the routine morbidity and mortality meetings at our institution, root-cause analysis is undertaken to review unexpected deaths.…”

Section: 6mentioning

confidence: 99%

Prophylactic proton pump inhibitors in femoral neck fracture patients – A life - and cost-saving intervention

Singh

Trickett

Meyer

et al. 2016

annals

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INTRODUCTION Acute gastrointestinal stress ulceration is a common and serious complication of trauma. Prophylactic proton pump inhibitors (PPIs) or histamine receptor antagonists have been used in poly-trauma, burns and head and spinal injuries, as well as on intensive care units, for the prevention of acute gastric stress ulcers. METHODS We prospectively studied the use of prophylactic PPIs in with femoral neck fracture patients, gathering data on all acute gastric ulcer complications, including coffee-ground vomiting, malena and haematemesis. We then implemented a treatment protocol in which all patients were given prophylactic PPIs, again prospectively collecting all data. RESULTS Five hundred and fifteen patients were included. Prior to prophylactic PPI, 15% of patients developed gastric stress ulcer complications, with 3% requiring acute intervention with oesophagogastroduodenoscopy (OGD), 5% requiring transfusions and 4% experiencing surgical delays. All patients had delayed discharges. Following PPI implementation, no patients developed gastric stress ulcer complications. CONCLUSIONS Femoral neck fracture patients create a substantial workload for orthopaedic units. The increasingly elderly population often have comorbidities, and concomitantly use medications with gastrointestinal side effects. This, combined with the stress of a fracture and preoperative starvation periods increases the risk of gastric ulcers. Here, the use of prophylactic PPIs statistically reduced the incidence of gastric stress ulcers in patients with femoral neck fractures, resulting in fewer surgical delays, reduced length of hospital stay and reduced stress ulcer-related mortality.

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“…4 The most recent Australian study that identifies length of stay (LOS) and hospital mortality for hip fracture patients describes only the acute episode of care. 5 Western Australia was the first Australian jurisdiction to practise systematic linkage of health databases 6,7 but to date has not reported data for patient-based linked episodes with respect to hip fracture. The true values for LOS, cost and outcomes of treatment for hip fracture in Australian hospitals remain unknown.…”

Section: Introductionmentioning

confidence: 99%