Causes of in-hospital mortality after hip fractures in the elderly

Abstract

Objectives: Although there are numerous studies reporting early mortality after hip fracture, the incidence and aetiology of in-hospital mortality following hip fractures is largely unknown. This study aimed to determine the causes and the incidence of in-hospital mortality in patients with a hip fracture who received surgical treatment. Methods: This was a multi-institutional retrospective study identifying 2464 consecutive patients >65 years of age who were treated for a hip fracture from 2000 to 2016 at 2 institutions. Revision surgeries were excluded. An electronic query followed by manual chart review was performed to collect patient demographics, Charlson comorbidity index (CCI), type of anaesthesia, and cause of death. Results: The overall in-hospital mortality rate for patients undergoing surgical intervention for an acute hip fracture was 3.0% (75/2464). The most common causes of death in descending order were: respiratory failure ( n = 26), cardiac failure ( n = 13), multiorgan failure ( n = 6), septic shock ( n = 6), pulmonary embolism ( n = 5), end stage renal disease ( n = 5) and others ( n = 14). In-hopsital mortality was associated with older age ( p = 0.001) and higher CCI scores ( p = 0.001). There was no association with gender ( p = 0.165), type of anaesthesia ( p = 0.497), extracapsular versus intracapsular fracture ( p = 0.627), pathologic versus non-pathologic fracture (0.799), or body mass index ( p = 0.781). Conclusion: This study demonstrated that hip fracture patients are at relatively high risk of in-hospital mortality following surgical intervention with a high proportion of patients succumbing to respiratory failure. The findings compel us to investigate strategies that can minimize mortality related to respiratory failure in this patient population such as minimising opioid use, early mobilisation, and implementing greater respiratory monitoring.

Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology

“…Kayani et al reported a similar mortality rate for COVID-negative hip fractures [7]. This rate has been previously reported to be as high as 3-5% during non-COVID times [8,9]. This raises the controversial issue of whether SARS-CoV-2 detection is sensitive enough or not in hip fracture patients [10].…”

“…Patients were not transferred to their corresponding bed/floor until the test was ready. Median time to rRT-PCR results was six hours (interquartile range [IQR], [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. No surgeries were performed with a pending rRT-PCR result.…”

A retrospective study of end-stage kidney disease patients on maintenance hemodialysis with renal osteodystrophy-associated fragility fractures

“…We found that the fracture group had more deaths from septic shock and multiple organ dysfunction than the CG, which supports our hypothesis. Studies by Groff [30], Dodd [31] and many scholars have also confirmed the association between secondary infection after fracture and patient death.…”

Association of age-related macular degeneration on fracture risks among osteoporosis population: a nationwide population-based cohort study

“…Although the chance of death is increased in patients with OS with systemic comorbidities, attention should be paid to the fact that these patients with additional AMD diagnosis have a higher risk of spine and hip fractures and subsequent death caused by fractures. 18 19 Therefore, we should aggressively treat AMD to prevent fractures in patients with OS if they are not affected by severe systemic diseases.…”

“… 17 Taiwan’s population is ageing at an alarming rate 15 ; OS and related fractures pose an unprecedented threat to the elderly population in Taiwan since the prevalence of OS increases rapidly with age. 14 As fractures in the elderly would contribute to a higher probability of mortality despite promptly surgical intervention, 18 19 potential risk factors for individuals vulnerable to fractures, such as those with OS, should be further investigated and identified.…”