Clinical characteristics and 1-year all-cause mortality in elderly hip fracture patients with type 2 diabetes mellitus: a propensity score matching study

Abstract

Aim Diabetes can seriously affect the prognosis of elderly patients with hip fractures. The aim of this study was to investigate the clinical characteristics and 1-year all-cause mortality in elderly hip fracture patients with type 2 diabetes mellitus (T2DM). Methods This retrospective study involved patients aged ≥ 65 years old after hip fracture surgery from 2017 to 2019. Patients were divided into T2DM group and non-T2DM group based on whether T2DM was diagnosed at admission. Propensity score matching (PSM) was performed in a ratio of 1:1 in the two groups for further comparison. Clinical outcomes included the laboratory results, imaging results, perioperative complications and 1-year all-cause mortality. Results In this study, a total of 1296 elderly hip fracture patients were collected, including 331 cases in T2DM group and 965 cases in non-T2DM group. After PSM, a total of 312 pairs of cases were obtained, and all baseline data were comparable (P > 0.05). The levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, Brain natriuretic peptide and C-reactive protein in T2DM group were higher than those in non-T2DM group, and the levels of high-density lipoprotein cholesterol was lower in T2DM group (P < 0.05). The level of left atrial diameter, left ventricular end-diastolic diameter, ventricular septal thickness and carotid medial thickness were higher in the T2DM group (P < 0.05). The incidence of perioperative anemia (56.1% vs 47.1%), hypoproteinemia (53.8% vs 45.8%), electrolyte disturbances (43.6% vs 30.4%), perioperative heart failure (41.3% vs 27.9%), perioperative arrhythmias (30.1% vs 17.6%), and lung infections (21.8% vs 12.2%) was statistically significant in T2DM group (P < 0.05). During the 1-year follow-up period, patients with T2DM were 2 times more likely to die than those without T2DM (HR = 2.104, 95% CI 1.437, 3.080). Conclusion Elderly patients with T2DM are more likely to have multiple comorbidities, they are more likely to have dyslipidemia and cardiac structural changes, the incidence of perioperative complications after hip fracture is high. T2DM is an independent risk factor for 1-year mortality in elderly patients with hip fractures, which increases the risk of death twofold. To improve the postoperative outcomes of patients with T2DM who have undergone hip fracture surgery, effective treatment models such as multidisciplinary collaboration and individualized management should be established.