Mortality rates for hip fracture patients managed surgically and conservatively in a dedicated unit in Singapore

Tan, Cheryl Marise Peilin; Park, Derek Howard; Chen, Ying Dong; Jagadish, Mallya Ullal; Su, Su; Premchand, Antony Xavier Rex

doi:10.1007/s00402-020-03605-1

Cited by 10 publications

(11 citation statements)

References 19 publications

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“… 1 For most hip fractures, surgery is recommended as the treatment of choice. 2 Unplanned readmission rate, an indicator used to measure the quality of healthcare and surgical outcome, often was associated with poor outcomes. 3 It was estimated that each unplanned readmission increased the postoperative 1-year mortality risk by 23.1% to 34.4%, 4 , 5 prolonged the hospitalization stay by an average of 8.7 days, and increased medical cost by 14,191 to 25,035 dollars.…”

Section: Introductionmentioning

confidence: 99%

Incidence, Causes, and Risk Factors of Unplanned Readmissions in Elderly Patients Undergoing Hip Fracture Surgery: An Observational Study

Tian¹,

Wang²,

Zhu³

et al. 2023

CIA

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Aim The purpose of this study was to examine the incidence and cause of unplanned readmission after Surgically Treated Hip Fractures in Elderly Patients and identify the associated risk factors. Methods This study retrospectively collected the data on elderly patients who underwent hip fracture surgery at two institutions from January 2020 to December 2021, and identified those who were readmitted within 12 months postoperatively. Based on the presence or not of postoperative readmission, they were divided into readmission and non-readmission groups. Demographics, surgery-related variables, and laboratory parameters were compared between groups. The specific causes for documented readmission were collected and summarized. Multivariate logistic regression analysis was performed to identify the associated risk factors. Results There were 930 patients including 76 (8.2%) patients who were readmitted within 12 months postoperatively. Overall, cardiac and respiratory complications and new-onset fractures were the first three common causes of readmission, taking an overwhelming proportion of 53.9% (41/76). Over 60% (61.8%, 47/76) of readmissions occurred within 30 days after surgery, with medical complications taking a predominance (89.4%, 42/47). New-onset fractures accounted for a proportion of 18.4% (14/76), occurring at different time points; especially, at 90–365 days, it accounted for 44.4% (8/18). Multivariate analysis revealed that age ≥80 years (OR, 1.0, 95% CI, 1.0 to 1.1; P=0.032), preoperative albumin level ≤21.5 g/L (OR, 1.1, 95% CI, 1.0 to 1.2; P=0.009), the postoperative occurrence of DVT (OR, 4.2, 95% CI, 2.5 to 7.2; P=0.001), and local anesthesia (OR, 2.1, 95% CI, 1.1 to 4.0; P=0.029) were independent risk factors for unplanned readmissions. Conclusion This study identified several risk factors for unplanned readmissions after elderly hip fractures, and provided detailed information about unplanned readmissions.

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Section: Introductionmentioning

confidence: 99%

Incidence, Causes, and Risk Factors of Unplanned Readmissions in Elderly Patients Undergoing Hip Fracture Surgery: An Observational Study

Tian¹,

Wang²,

Zhu³

et al. 2023

CIA

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“…Surgical therapy for intertrochanteric fracture was associated with lower long-term mortality, which was consistent with a Singapore study. 20 According to Guidelines for management of geriatric femoral intertrochanteric fractures, 15 surgical therapy was recommended for patients after intertrochanteric fracture except those with extremely severe diseases or with short expected survival time. But in practice in China, a great number of patients had not chosen surgical therapy after fractures because of various reasons.…”

Section: Mortality Rates and Therapymentioning

confidence: 99%

“…In fact, a significant number of patients are still treated conservatively for various reasons in our clinical practice, such as fear of surgery, high cost of surgery and other reasons. Recent studies reported that the proportions of conservative treatment reached 11.00%–23.07% 20–23 . There are no sufficient studies comparing the mortality between surgical and conservative management 20–23 .…”

Section: Introductionmentioning

confidence: 99%

Excess Mortality for Femoral Intertrochanteric Fracture Patients Aged 50 Years and Older Treated Surgically and Conservatively in Tianjin, China: A Cohort Study

Cui,

Zhao,

Zhao

et al. 2023

Orthopaedic Surgery

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ObjectiveIntertrochanteric fracture is one type of hip fracture, which is the most serious consequence of osteoporosis. Along with the growing elderly population, intertrochanteric fracture is expected to rise increasingly. The aim of this study was to assess excess mortality after intertrochanteric fractures and to identify the predictors of long‐term mortality by therapy among patients aged 50 years and older in Tianjin.MethodsThis is a retrospective cohort study on mortality for 3029 patients aged 50 years and older in Tianjin experiencing an intertrochanteric fracture between December 26, 2014 and December 31, 2018. Data were from Tianjin Hospital Hip Fracture (THHF) cohort. Follow‐up period was until March 31, 2022. Mortality, excess mortality, and comorbidities were analyzed and stratified by therapy and gender. Time dependent Cox models were performed to estimate the effects of the variables.ResultsAbsolute mortality for all the patients was 5.90% at 3 months, 12.55% at 12 months, 19.92% at 24 months and 27.28% at 36 months. Absolute mortality for surgical group was 1.57% at 3 months, 4.77% at 12 months, 8.49% at 24 months and 12.07% at 36 months, significantly lower than conservative group: 10.50% at 3 months, 20.73% at 12 months, 31.96% at 24 months and 43.04% at 36 months. We found a substantially lower mortality (hazard ratio [HR] 0.34, 95% confidence internal, [CI]: 0.23–0.52, p = 0.000) among patients undergoing surgical therapy than those undergoing conservative therapy, even when controlled for gender, age, the length of hospital stay, and all the comorbidities. Female patients (HR 0.68, 95% CI: 0.58–0.79, p = 0.000) were less likely to die than male patients after an intertrochanteric fracture. Patients treated by the two methods were both found to have excess mortality rates compared to the general population, although in different levels. The excess mortality rates for patients in the conservative therapy group were 14.46% in males and 17.93% in females, while in the surgical therapy group, 2.78% in females and 4.37% in males. The comorbidities moderate or severe renal disease (HR 2.19, 95% CI: 1.61–2.98, p = 0.000), metastatic solid tumor (HR 6.35, 95% CI: 1.56–25.85, p = 0.010), hypoproteinemia (HR 1.22, 95% CI: 1.01–1.47, p = 0.034), and older age (HR 1.89, 95% CI: 1.73–2.08, p = 0.000) were also risk factors on mortality. A worse‐case analysis for the primary outcome were performed as sensitivity analysis and it was consistent with the original conclusion.ConclusionIntertrochanteric factures for people aged 50 years older were found to have excess mortality compared to the general population in Tianjin city, and preventing the fractures in the hip for elderly people was imperative. After controlling tfor comorbidities and age, female gender and surgical therapy were protective factors for the death after fractures, which could provide strong evidence for patients and surgeons to make decisions.

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“…Hip fracture affects not only the patient's ability to perform activities of daily living (ADL), but also life prognosis. Regarding mortality, the percentage of older adults with a fractured hip who die within a year of injury is as high as 30%, while approximately 7% die during hospitalization [3][4][5]. Therefore, it is crucial to develop a concrete strategy for treating patients with hip fractures, especially older people.…”

Section: Introductionmentioning

confidence: 99%

Early surgical treatment using regional clinical pathways reduces the length of postoperative hospitalization in hip fracture patients: A retrospective analysis using the Japanese Diagnosis Procedure Combination database

Nishimura

Suzuki

Tokutsu

et al. 2023

Preprint

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Background: Hip fracture is a common injury in older people, especially those with weak bone contracture such as in osteoporosis. Although early surgical treatment is recommended, the optimal timing has not yet been determined in Japan. Therefore, we ascertained the rate of early surgery among hip fracture patients and investigated its effectiveness, along with regional clinical pathways, in reducing the length of postoperative hospital stay among patients with hip fractures. We used the Japanese Diagnosis Procedure Combination (DPC) database to obtain data for this study. Methods: We used data of patients diagnosed with femoral neck and peritrochanteric fractures retrieved from the Japanese DPC database between April 2016 and March 2018. Patients were divided into the early surgery (43,928 [34%] patients who underwent surgery within two days of admission) and delayed surgery groups (84,237 [66%] patients who underwent surgery after two days of admission). Results: The difference between the length of stay (LOS) in the hospital for both groups was two days (early vs. delayed: 21 days vs. 23 days). The early surgery group had more cases of intertrochanteric fractures (57% vs. 43%) and internal fixation (74% vs. 55%) than the delayed surgery group. In contrast, the delayed surgery group had more cases of femoral neck fractures (43% vs. 57%) and bipolar hip arthroplasty (25% vs. 42%) or total hip arthroplasty (1.2% vs. 3.0%). Moreover, the early surgery group showed a lower incidence of complications, except anaemia (12 % vs. 8.8%), than the delayed surgery group. Logistic regression analysis using the adjusted model showed that early surgery and implementation of regional clinical pathways reduced LOS by 2.58 and 8.06 days, respectively (p < 0.001). Conclusions: Early surgery was performed in a third of all hip fracture patients. Early surgery and implementation of regional clinical pathways for hip fracture patients are effective in reducing postoperative hospital LOS, with regional clinical pathways having a greater impact. These findings will help acute care providers when treating patients with hip fractures.

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Mortality rates for hip fracture patients managed surgically and conservatively in a dedicated unit in Singapore

Cited by 10 publications

References 19 publications

Incidence, Causes, and Risk Factors of Unplanned Readmissions in Elderly Patients Undergoing Hip Fracture Surgery: An Observational Study

Incidence, Causes, and Risk Factors of Unplanned Readmissions in Elderly Patients Undergoing Hip Fracture Surgery: An Observational Study

Excess Mortality for Femoral Intertrochanteric Fracture Patients Aged 50 Years and Older Treated Surgically and Conservatively in Tianjin, China: A Cohort Study

Early surgical treatment using regional clinical pathways reduces the length of postoperative hospitalization in hip fracture patients: A retrospective analysis using the Japanese Diagnosis Procedure Combination database

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