Impact of Dementia on Long-Term Hip Fracture Surgery Outcomes: An Electronic Health Record Analysis

Xue, Tingzhong; Pan, Wei; Tsumura, Hideyo; Wei, Sijia; Lee, Chiyoung; McConnell, Eleanor S.

doi:10.1016/j.jamda.2022.11.006

Cited by 6 publications

(5 citation statements)

References 48 publications

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“…Even Xue et al detected a significantly higher 1-year mortality and risk of death for hip fracture patients with dementia, comparable to our results [ 36 ]. Similar 30 day and 1-year mortality rates compared to our study were also confirmed in a study that included 9394 hip fracture patients with dementia.…”

Section: Discussionsupporting

confidence: 91%

“…Overall mortality was 13% and 37% after 30 days and 1 year, respectively [ 37 ]. Of note, it was demonstrated that arthroplasty was protective over internal fixation in terms of 1-year mortality in this subgroup of hip fracture patients [ 36 , 37 ]. With regard to the short life expectancy of cognitive impaired patients demonstrating a 5-year survival rate of less than 20% in our study hemiarthroplasty seems to be a valid treatment option.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany

Fakler,

Pieroh,

Höch

et al. 2024

Patient Saf Surg

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Background Mortality of patients with a femoral neck fracture is high, especially within the first year after surgery, but also remains elevated thereafter. The aim of this study was to identify factors potentially associated with long-term mortality in patients homogeneously treated with hemiarthroplasty for femoral neck fracture. Methods This retrospective cohort study was performed at a single level 1 national trauma center at the university hospital of Leipzig (Saxony, Germany). The study time-window was January 1, 2010 to December 31, 2020. Primary outcome measure was mortality depending on individual patient-related characteristics and perioperative risk factors. Inclusion criteria was a low-energy femoral neck fracture (Garden I-IV) in geriatric patients 60 years of age or older that were primarily treated with bipolar hemiarthroplasty. Date of death or actual residence of patients alive was obtained from the population register of the eastern German state of Saxony, Germany. The outcome was tested using the log-rank test and plotted using Kaplan-Meier curves. Unadjusted and adjusted for other risk factors such as sex and age, hazard ratios were calculated using Cox proportional hazards models and presented with 95% confidence intervals (CI). Results The 458 included patients had a median age of 83 (IQR 77–89) years, 346 (75%) were female and 113 (25%) male patients. Mortality rates after 30 days, 1, 5 and 10 years were 13%, 25%, 60% and 80%, respectively. Multivariate regression analysis revealed age (HR = 1.1; p < 0.001), male gender (HR = 1.6; p < 0.001), ASA-Score 3–4 vs. 1–2 (HR = 1.3; p < 0.001), dementia (HR = 1.9; p < 0.001) and a history of malignancy (HR = 1.6; p = 0.002) as independent predictors for a higher long-term mortality risk. Perioperative factors such as preoperative waiting time, early surgical complications, or experience of the surgeon were not associated with a higher overall mortality. Conclusions In the present study based on data from the population registry from Saxony, Germany the 10-year mortality of older patients above 60 years of age managed with hemiarthroplasty for femoral neck fracture was 80%. Independent risk factors for increased long-term mortality were higher patient age, male gender, severe comorbidity, a history of cancer and in particular dementia. Perioperative factors did not affect long-term mortality.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany

Fakler,

Pieroh,

Höch

et al. 2024

Patient Saf Surg

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“…The postoperative mortality rate following hip fracture surgeries increases as time goes by (Bai et al, 2018; Hou et al, 2021). Indeed, a study conducted in the same institution as this study found a statistical significance in both 6-month mortality (hazard ratio = 1.69; p = .003) and 1-year mortality (hazard ratio = 1.78; p < .0001) in older adults with dementia following hip fracture surgery (Xue et al, 2022). Thus, one of the plausible explanations might be that the postoperative 30 days were not long enough to see the effect of dementia.…”

Section: Discussionmentioning

confidence: 56%

“…In our study, 67.1% ( n = 194 of 289) of patients with dementia were admitted from home, yet only 5.2% ( n = 15) of them were discharged home. Indeed, in another study, patients with dementia had 2.11-fold higher odds of being discharged to a location other than their home, such as another hospital or skilled nursing facility (Xue et al, 2022). Many older patients following a hip fracture surgery endure multiple transitions of care (e.g., hospital to long-term care facility).…”

Section: Discussionmentioning

confidence: 99%

Impact of Dementia on Incidence and Severity of Postoperative Pulmonary Complications Following Hip Fracture Surgery Among Older Patients

Tsumura,

McConnell,

Xue

et al. 2023

Clin Nurs Res

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Postoperative pulmonary complications (PPCs) are the leading cause of death following hip fracture surgery. Dementia has been identified as a PPC risk factor that complicates the clinical course. By leveraging electronic health records, this retrospective observational study evaluated the impact of dementia on the incidence and severity of PPCs, hospital length of stay, and postoperative 30-day mortality among 875 older patients (≥65 years) who underwent hip fracture surgery between October 1, 2015 and December 31, 2018 at a health system in the southeastern United States. Inverse probability of treatment weighting using propensity scores was utilized to balance confounders between patients with and without dementia to isolate the impact of dementia on PPCs. Regression analyses revealed that dementia did not have a statistically significant impact on the incidence and severity of PPCs or postoperative 30-day mortality. However, dementia significantly extended the hospital length of stay by an average of 1.37 days.

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“…Postoperative care for this patient cohort remains a significant challenge for the health care system. These patients display an increased fall risk, increased mortality, increased readmission rates, and a greater dependence on ADLs compared with those without dementia 61-63 . Patients with dementia also have higher rates of discharge to permanent care facilities 26 .…”

Section: Rehabilitation and Postoperative Carementioning

confidence: 99%

Dementia and Hip Fractures

Zabawa,

Choubey,

Drake

et al. 2023

JBJS Reviews

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» The elderly population is the fastest growing demographic, and the number of dementia cases in the United States is expected to double to 10 million by 2050.» Patients with dementia are at 3× higher risk of hip fractures and have higher morbidity and mortality after hip fractures.» Hip fracture patients with dementia benefit from early analgesia and timely surgical fixation of fracture.» Early and intensive inpatient rehabilitation is associated with improved postoperative outcomes in patients with dementia.» Coordination of care within a “orthogeriatric” team decreases mortality, and fracture liaison services show potential for improving long-term outcomes in hip fracture patients with dementia.

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Impact of Dementia on Long-Term Hip Fracture Surgery Outcomes: An Electronic Health Record Analysis

Cited by 6 publications

References 48 publications

Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany

Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany

Impact of Dementia on Incidence and Severity of Postoperative Pulmonary Complications Following Hip Fracture Surgery Among Older Patients

Dementia and Hip Fractures

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