Long‐term sex differences in all‐cause and <scp>infection‐specific</scp> mortality post hip fracture

Bajracharya, Rashmita; Guralnik, Jack M.; Shardell, Michelle; Rathbun, Alan M.; Yamashita, Takashi; Hochberg, Marc C.; Gruber‐Baldini, Ann L.; Magaziner, Jay; Orwig, Denise

doi:10.1111/jgs.17800

Cited by 9 publications

(12 citation statements)

References 26 publications

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Section: Discussionsupporting

confidence: 93%

“…Our results were congruent with previous studies that have reported higher risk of post-fracture mortality among men [ 42 , 43 ]. This could be due to higher rate of pre-existing comorbidities and post-fracture infections, and lower use of pre- and post-fracture osteoporosis medications [ 42 , 44 ]. Additional studies are needed to understand how the usage of pre-injury medications differed across sex in patients with hip fractures in Victoria and the impact on post-fracture outcomes and mortality.…”

Section: Discussionsupporting

confidence: 93%

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Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study

et al. 2023

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Summary Hip fractures are a major public health concern. Number of hip fractures cases increased by 20% from 2012 to 2018. Factors associated with post-fracture mortality included men, those who are frail, living in a non-metropolitan region, or residing in a residential aged care facility. Our results are useful for planning healthcare interventions. Purpose Hip fractures are a major public health concern in Australia. Data on hip fracture incidence and mortality are needed to plan and evaluate healthcare interventions. The aims of the study were to investigate (1) the time-trend in absolute number and incidence of first hip fractures, and (2) factors associated with mortality following first hip fractures in Victoria, Australia. Methods A state-wide cohort study of all patients aged $$\ge$$ ≥ 50 years admitted to a Victorian hospital for first hip fracture between July 2012 and June 2018. Annual age-standardized incidence rates were calculated using population data from Australian Bureau of Statistics. Multivariate negative binomial regression was used to investigate factors associated with post-fracture mortality. Results Overall, 31,578 patients had a first hip fracture, of whom two-thirds were women and 47% were $$\ge$$ ≥ 85 years old. Absolute annual numbers of first hip fractures increased by 20%. There was no significant change in age- and sex-adjusted incidence. In total, 8% died within 30 days and 25% within 1 year. Factors associated with 30-day mortality included age (≥ 85 years old versus 50–64 years old, mortality rate ratio [MRR] 8.05, 95% confidence interval [CI] 5.86–11.33), men (MRR 2.11, 95% CI 1.88–2.37), higher Hospital Frailty Risk Scores (high frailty versus no frailty, MRR 3.46, 95% CI 2.66–4.50), admission from a residential aged care facility (RACF) (MRR 2.28, 95% CI 1.85–2.82), and residing in a non-metropolitan region (MRR 1.22, 95% CI 1.09–1.38). The same factors were associated with 1-year mortality. Conclusion The absolute increase in hip fractures highlights the need for interventions to reduce fracture risk, especially for those at higher risk of post-fracture mortality, including men and those who are frail, living in a non-metropolitan region, or residing in a RACF.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study

et al. 2023

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“…7 Prior work has consistently shown sex differences in hip fracture recovery, with men generally faring worse in functional and mortality outcomes. [8][9][10] Many hypotheses have been developed to explain the sex differences. Primarily, males have greater bone mineral density (BMD) compared to females over the lifetime, and do not experience a precipitous loss in BMD like females during menopause.…”

Section: Introductionmentioning

confidence: 99%

Associations of sex, Alzheimer's disease and related dementias, and days alive and at home among older Medicare beneficiaries recovering from hip fracture

Mutchie

Orwig

Gruber‐Baldini

et al. 2023

J American Geriatrics Society

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BackgroundMales constitute 25% of older adults who experience hip fractures in the United States; a concerning upward trend given poorer health and outcomes among male survivors. Male sex is associated with worse cognitive performance after hip fracture, impacting participation in rehabilitation and long‐term outcomes especially for those with Alzheimer's disease or related dementias (ADRD). However, little research has evaluated whether sex differences in post‐fracture recovery are greater among those living with ADRD.MethodsData were drawn from 2010 to 2017 Medicare fee‐for‐service beneficiaries aged 65 years and older who survived hospitalization for hip fracture (n = 69,581). The primary outcome was days alive and at home (DAAH), a validated patient‐centered claims‐based outcome calculated as 365 days from fracture minus days in hospital, nursing home, rehabilitation facility, emergency department, or time after death. Multivariable Poisson regressions with an interaction term between sex and ADRD status were to model the association between DAAH and ADRD in the 12 months post hip fracture, adjusting for demographics, injury severity, chronic disease burden, and hospital‐level fixed effects.ResultsCompared to females, males were younger and had more comorbidities at the time of fracture. Among survivors, males with ADRD spent a mean of 160.7 DAAH compared to 228.4 for males without ADRD, 177.8 for females with ADRD, and 248.0 for females without ADRD. In adjusted analyses, males without ADRD spent 8.2% fewer DAAH compared to females (rate ratio [RR] = 0.92, 95% CI 0.92–0.92). This relative sex difference increased significantly when comparing those living with ADRD, with males spending an additional 3.3% fewer DAAH (interaction RR = 0.96, 95% CI 0.96–0.97).ConclusionsMales spend fewer DAAH after hip fracture than females, and this difference increases modestly for males living with ADRD compared to females. This suggests that cognitive impairment may be a small but significant contributor to sex‐based differences observed during hip fracture recovery.

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“…[17] The combined underlying disease is also a susceptible cause of postoperative incisional infections. [18] The results of the study showed that having diabetes is a risk factor for postoperative incisional infection in patients with ankle fractures. Patients with diabetes often have decreased body immunity and poor body composition, and elevated blood glucose provides a good environment for bacteria to survive and reproduce.…”

Section: Discussionmentioning

confidence: 93%

Construction and validation of a nomogram prediction model for postoperative incisional infection in ankle fractures

Deng

2023

Medicine

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The aim was to investigate the independent risk factors for postoperative incisional infection in ankle fractures and to establish a nomogram prediction model accordingly. Data were collected from ankle fracture patients in the Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for postoperative incisional infection in ankle fractures and to establish the corresponding nomogram. Receiver operating characteristic curves were plotted and area under the curve was calculated, and calibration curves and decision curve analysis were plotted to evaluate the model performance. A total of 722 patients with ankle fractures were included in the study, and 76 patients developed postoperative incisional infections, with an incidence of 10.53%. After univariate and multivariate logistic regression analysis, a total of 5 variables were identified as independent risk factors for postoperative incisional infection in ankle fractures, namely, age ≥ 60 years (OR, 1.885; 95% CI, 1.156–3.045), having diabetes (OR1.625; 95% CI, 1.095–2.876), open fracture (OR, 5.564; 95% CI, 3.099–9.990), albumin < 35 g/L (OR, 2.618; 95% CI, 1.217–4.215), and operative time ≥ 2 hours (OR, 1.606; 95% CI, 1.077–3.247). The nomogram for postoperative incisional infection after ankle fracture constructed in this study has good predictive accuracy and helps orthopedic surgeons to intervene earlier in patients at high risk of postoperative incisional infection after ankle fracture.

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Long‐term sex differences in all‐cause and infection‐specific mortality post hip fracture

Cited by 9 publications

References 26 publications

Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study

Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study

Associations of sex, Alzheimer's disease and related dementias, and days alive and at home among older Medicare beneficiaries recovering from hip fracture

Construction and validation of a nomogram prediction model for postoperative incisional infection in ankle fractures

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