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      One-year mortality rate after fragility hip fractures and associated risk in Nan, Thailand

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          Abstract

          Objectives

          Fragility hip fracture is a common secondary complication of osteoporosis, which leads to significant morbidity and mortality. The incidence and prevalence of hip fractures have increased over recent decades. This study established an objective to determine the mortality rate and potential risk factors in fragility hip fracture patients.

          Methods

          Electronic medical records were retrospectively reviewed. A total of 1412 patients, aged 50 years and over, who sustained and received treatment for hip fractures between 2014 and 2018 were subsequently identified. Mortality rate data were retrieved from the official statistics registry for the provincial population. The mortality rates and potential risk factors for mortality were examined using Kaplan-Meier estimates and multivariate Cox proportional hazard models.

          Results

          The overall 1-year mortality rate of fragility hip fracture patients was 19%. Compared with the age-matched population in Nan province, hip fractures increased the mortality rate by 6.21 times. Additionally, the mortality of hip fracture patients was significantly higher among those with age above 80 years, nonambulatory status before fracture and upon hospital discharge, end-stage renal disease, delirium, and pneumonia.

          Conclusions

          Patients who sustained hip fractures had approximately 6 times higher mortality. Effective strategies for hip fracture prevention as well as improvement in the standard of care are crucial steps towards reducing mortality in patients with hip fracture.

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          Early mortality after hip fracture: is delay before surgery important?

          Ronald K. Taylor, Allisyn Moran, Russell T Wenn … (2005)
          Hip fracture is associated with high mortality among the elderly. Most patients require surgery, but the timing of the operation remains controversial. Surgery within twenty-four hours after admission has been recommended, but evidence supporting this approach is lacking. The objective of this study was to determine whether a delay in surgery for hip fractures affects postoperative mortality among elderly patients. We conducted a prospective, observational study of 2660 patients who underwent surgical treatment of a hip fracture at one university hospital. We measured mortality rates following the surgery in relation to the delay in the surgery and the acute medical comorbidities on admission. The mortality following the hip fracture surgery was 9% (246 of 2660) at thirty days, 19% at ninety days, and 30% at twelve months. Of the patients who had been declared fit for surgery, those operated on without delay had a thirty-day mortality of 8.7% and those for whom the surgery had been delayed between one and four days had a thirty-day mortality of 7.3%. This difference was not significant (p = 0.51). The thirty-day mortality for patients for whom the surgery had been delayed for more than four days was 10.7%, and this small group had significantly increased mortality at ninety days (hazard ratio = 2.25; p = 0.001) and one year (hazard ratio = 2.4; p = 0.001). Patients who had been admitted with an acute medical comorbidity that required treatment prior to the surgery had a thirty-day mortality of 17%, which was nearly 2.5 times greater than that for patients who had been initially considered fit for surgery (hazard ratio = 2.3, 95% confidence interval = 1.6 to 3.3; p < 0.001). The thirty-day mortality following surgery for a hip fracture was 9%. Patients with medical comorbidities that delayed surgery had 2.5 times the risk of death within thirty days after the surgery compared with patients without comorbidities that delayed surgery. Mortality was not increased when the surgery was delayed up to four days for patients who were otherwise fit for hip fracture surgery. However, a delay of more than four days significantly increased mortality.
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            Similar mortality rates in hip fracture patients over the past 31 years

            Simran Mundi, Bharadwaj Pindiprolu, Nicole Simunovic … (2014)
            Background Over 320,000 hip fractures occur in North America each year and they are associated with a mortality rate ranging from 14% to 36% within 1 year of surgery. We assessed whether mortality and reoperation rates have improved in hip fracture patients over the past 31 years. Methods 3 electronic databases were searched for randomized controlled trials on hip fracture management, published between 1950 and 2013. Articles that assessed the surgical treatment of intertrochanteric or femoral neck fractures and measured mortality and/or reoperation rates were obtained. We analyzed overall mortality and reoperation rates, as well as mortality rates by fracture type, comparing mean values in different decades. Our primary outcome was the change in 1-year postoperative mortality. Results 70 trials published between 1981 and 2012 were included in the review. Overall, the mean 1-year mortality rate changed from 24% in the 1980s to 23% in the 1990s, and to 21% after 1999 (p = 0.7). 1-year mean mortality rates for intertrochanteric fractures diminished from 34% to 23% in studies published before 2000 and after 1999 (p = 0.005). Mean mortality rates for femoral neck fractures were similar over time (∼20%). Reoperation rates were also similar over time. Interpretation We found similar mortality and reoperation rates in surgically treated hip fracture patients over time, with the exception of decreasing mortality rates in patients with intertrochanteric fractures.
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              Dementia and delirium, the outcomes in elderly hip fracture patients

              Christina Mosk, Marnix Mus, Jos Vroemen … (2017)
              Background Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. Methods This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Results Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P<0.001), institutionalization (P<0.001), and 6-month mortality (P<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P<0.001) but a shorter hospital stay (P<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%). Conclusion Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.
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                Author and article information

                Contributors
                Nuttorn Daraphongsataporn
                Journal
                Journal ID (nlm-ta): Osteoporos Sarcopenia
                Journal ID (iso-abbrev): Osteoporos Sarcopenia
                Title: Osteoporosis and Sarcopenia
                Publisher: Korean Society of Osteoporosis
                ISSN (Print): 2405-5255
                ISSN (Electronic): 2405-5263
                Publication date PMC-release: 23 June 2020
                Publication date (Print): June 2020
                Publication date (Electronic): 23 June 2020
                Volume: 6
                Issue: 2
                Pages: 65-70
                Affiliations
                [a ]Department of Orthopaedic Surgery, Nan Hospital, Nan, Thailand
                [b ]Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
                Author notes
                [∗ ]Corresponding author. Department of Orthopaedic Surgery, Nan Hospital, 1 Worawichai Rd., Nai Waing, Muang Nan, Nan, 55000, Thailand. nuttorndara@ 123456gmail.com
                Article
                Publisher ID: S2405-5255(20)30052-2
                DOI: 10.1016/j.afos.2020.05.005
                PMC ID: 7374531
                PubMed ID: 32715096
                SO-VID: 393aa651-59a1-4f87-bd51-baaac7d2f299
                Copyright © © 2020 The Korean Society of Osteoporosis. Publishing services by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 3 December 2019
                Date revision received : 12 February 2020
                Date accepted : 21 May 2020
                Categories
                Subject: Original Article

                Keywords: osteoporotic hip fracture,fragility hip fracture,mortality rate,risk factors
                Data availability:
                Keywords: osteoporotic hip fracture, fragility hip fracture, mortality rate, risk factors

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