Excess Mortality After Pelvic Fractures Among Older People

Abstract

The study aimed to estimate excess mortality in patients aged 60 years or older up to 1 year after pelvic fracture compared with a population without pelvic fracture. In this retrospective population-based observational study, we use routine data from a large health insurance in Germany. For each patient with a first pelvic fracture between 2008 and 2010 (n ¼ 5685 cases, 82% female, mean age 80 AE 9 years), about 34 individuals without pelvic fracture (n ¼ 193,159 controls) were frequency matched by sex, age at index date, and index month. We estimated survival probabilities in the first year after the index date separated for cases (further stratified into inpatient/ outpatient treated or minor/major pelvic fractures) and controls using Kaplan-Meier curves. Additionally, time-dependent hazard ratios (HRs) measuring excess mortality in 4-week intervals up to 52 weeks were estimated by fitting Cox regression models including adjustment for relevant confounders. Twenty-one percent of cases and 11% of controls died within 1 year. HRs (95% confidence intervals) decreased from 3.9 (3.5-4.5) within the first 4 weeks to 1.4 (1.1-1.9) within weeks 49 to 52 after the index date. After full adjustment, HRs lowered substantially (3.0 [2.6-3.4] and 1.0 [0.8-1.4]) but were still significantly increased up to week 32. Adjusted HRs in women were lower than in men: 2.8 (2.4-3.2) and 1.0 (0.7-1.4) versus 3.8 (2.9-5.0) and 1.2 (0.6-2.3). We found a clear excess mortality among older people in the first 8 months after pelvic fracture even after full adjustment. Excess mortality was higher among men in the beginning as well as for inpatienttreated persons. Absence of excess mortality was noticed for outpatient-treated persons within the first 3 months. When broken down into site-specific data, excess mortality was no longer significant for most pelvic fractures classified as minor. The only exception was fracture of pubis within the first 4 weeks.

Osteoporotic Pelvic Fractures

“…The reported average duration of hospital stay ranges from 9.3 to 45 days (3,14). The 1-year mortality ranges from 9.5% to 27% (3,13,33); these figures are similar to those reported for proximal femur fractures. Hill et al even reported a 5-year mortality of 54.4% (34).…”

In-screw polymethylmethacrylate-augmented sacroiliac screw for the treatment of fragility fractures of the pelvis: a prospective, observational study with 1-year follow-up

“…In consideration of these data [ 6 , 29 , 30 ] and the excess of mortality following a pelvic ring fracture in the elderly [ 31 ], surgical treatment might be favored especially for patients suffering from persistent pain and immobilization following a conservative treatment [ 12 ].…”

Biomechanics of Osteoporotic Fracture Fixation

“…Pelvis fractures constitute a significant clinical problem [6] [80] as they cause intense pain and immobility, impair the quality of life, and lead to loss of patients' independence [81]. In the elderly population, pelvis fractures are associated with a high morbidity and mortality with up to 27% of patients dying within 1 year of surgery [82,83].…”