30-day mortality after hip fracture surgery: Influence of postoperative factors

Abstract

Purpose The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. The aim of this work is to analyse preoperative and postoperative factors potentially related to early 30-day mortality in patients over 65 undergoing hip fracture surgery. Methods Prospective cohort study including all consecutive primary hip fracture patients over 65 admitted to Trauma and Orthopaedics department from January 1, 2018 to December 31, 2019. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral aetiology fractures were excluded. A total of 943 patients were eligible (attrition rate: 2.1%). Follow-up included 30-days after discharge. We noted the 30-day mortality after hip fracture surgery, analysing 130 potentially related variables including biodemographic, fracture-related, preoperative, and postoperative clinical factors. Qualitative variables were assessed by χ2, and quantitative variables by non-parametric tests. Odds ratio determined by binary logistic regression. We selected preventable candidate variables for multivariate risk assessment by logistic regression. Results A total of 923 patients were enrolled (mean age 86.22±6.8, 72.9% women). The 30-day mortality rate was 6.0%. We noted significant increased mortality on men (OR = 2.381[1.371–4.136], p = 0.002), ageing patients (ORyear = 1.073[1.025–1.122], p = 0.002), and longer time to surgery (ORday = 1.183[1.039–1146], p<0.001), on other 20 preoperative clinical variables, like lymphopenia (lymphocyte count <103/μl, OR = 1.842[1.063–3.191], p = 0.029), hypoalbuminemia (≤3.5g/dl, OR = 2.474[1.316–4.643], p = 0.005), and oral anticoagulant intake (OR = 2.499[1.415–4.415], p = 0.002), and on 25 postoperative clinical variables, like arrhythmia (OR = 13.937[6.263–31.017], p<0.001), respiratory insufficiency (OR = 7.002[3.947–12.419], p<0.001), hyperkalaemia (OR = 10.378[3.909–27.555], p<0.001), nutritional supply requirement (OR = 3.576[1.894–6.752], p = 0.021), or early arthroplasty dislocation (OR = 6.557[1.206–35.640], p = 0.029). We developed a predictive model for early mortality after hip fracture surgery based on postoperative factors with 96.0% sensitivity and 60.7% specificity (AUC = 0.863). Conclusion We revealed that not only preoperative, but also postoperative factors have a great impact after hip fracture surgery. The influence of post-operative factors on 30-day mortality has a logical basis, albeit so far they have not been identified or quantified before. Our results provide an advantageous picture of the 30-day mortality after hip fracture surgery.

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

“…The 30-day mortality rate for patients with a perioperative diagnosis of SARS-CoV-2 infection undergoing surgery for proximal femoral fracture is substantial. An overall rate of 29.4% compares with the reported 30-day mortality in the literature for proximal femoral fractures ranging between 3.5% and 6.8% 2 28–32. This rate is higher than found at the 1 year time point 33.…”

Trends in Hip Fracture Incidence, Length of Hospital Stay, and 30-Day Mortality in Sweden from 1998–2017: A Nationwide Cohort Study

“…Fourth, reliable data on cause-specific deaths are not available from Swedish national registers. Yet, for the outcome 30-day mortality after a hip fracture, the operation and fracture are generally regarded as strong contributing causes of death, with complications including infection and cardiovascular disease [ 38 , 39 ]. The strengths of the study include the long study duration of 20 years, the use of national registers, which ensured complete coverage of all hip fractures in Sweden and no loss to follow-up for 30-day mortality, altogether increasing the external and internal validity of the study results.…”

A risk scoring system integrating postoperative factors for predicting early mortality after major non‐cardiac surgery

“…There are several risk scores and models for predicting mortality after major surgery, most of which utilize pre‐ and intraoperative factors 3–7 . However, postoperative factors may significantly impact postoperative mortality 8 . Moreover, mortality risk factors may change in different postoperative periods 5 …”

“…[3][4][5][6][7] However, postoperative factors may significantly impact postoperative mortality. 8 Moreover, mortality risk factors may change in different postoperative periods. 5 Neutrophils, lymphocytes, and platelets play essential roles in mediating innate and adaptive immune responses.…”

“… 3 , 4 , 5 , 6 , 7 However, postoperative factors may significantly impact postoperative mortality. 8 Moreover, mortality risk factors may change in different postoperative periods. 5 …”