obesity paradox and mortality after pathological hip fractures: a Swedish registry study

Abstract

Background and purpose — Obesity as measured by BMI has been associated with increased survival in various diseases, a phenomenon known as the “obesity paradox.” It is unknown whether obesity is associated with survival after pathological fractures. We investigated the association between BMI and survival after surgery for pathological hip fracture, to improve survival prognostication, and lay grounds for further interventional nutritional studies. Patients and methods — We analyzed prospectively collected data from Swedish nationwide registry “RIKSHÖFT.” The study cohort included 1,000 patients operated for a pathological hip fracture between 2014 and 2019. BMI registered on admission was available in 449 patients. Overall patient survival was measured according to the Kaplan–Meier method. Multivariable regression was used to evaluate association with other potential factors that influence patient survival. Results — Overweight and obesity were associated with an increased postoperative survival in male patients with surgically treated pathological hip fractures. Multivariable analysis considering potential confounders confirmed this finding. The association was not that strong in women and did not reach statistical significance. Interpretation — BMI, a commonly available clinical parameter, is a good predictor of overall survival for patients operated on for pathological hip fracture. Incorporation of BMI in existent survival prognostication algorithms should be considered. Treatment of malnutrition in this frail group of patients is worth studying.

Influence of comorbidity on postoperative course and mortality in patients with hip fracture

“…It is estimated that only one-fifth of patients who walked independently before the fracture do so six months after the fracture [19,27]. About 78.4% of patients with proximal femoral fracture treated with a surgical technique had a higher one-year survival rate (72%) than those treated conservatively (50%) [19,28]. Numerous studies show that delaying surgery after 72 hours of fracture approximately doubles the risk of death before the end of the first year after surgery and is a very important risk factor for mortality [12][13][14][15][16]27].…”