Predictive factors of mortality of patients with fragility hip fractures at 1 year after discharge: A multicenter, retrospective study in the northern Kyushu district of Japan

Abstract

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). AbstractPurpose: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. Methods: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. Results: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8-12.0%, n ¼ 45). Log-rank test revealed that previous fractures (p ¼ 0.003), Barthel index (BI) at discharge (p ¼ 0.011), and place-to-discharge (p ¼ 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p ¼ 0.023), total Charlson comorbidity index (TCCI; p ¼ 0.005), smoking (p ¼ 0.007), length of hospital stay (LOS; p ¼ 0.009), and BI (p ¼ 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p ¼ 0.044), and BI <30 (HR 5.42, p ¼ 0.013) were the predictive variables of mortality for male patients. BMI <18.5 kg/m 2 (HR 2.70, p ¼ 0.023), TCCI 5 (HR 2.61, p ¼ 0.032), smoking history (HR 3.59, p ¼ 0.018), LOS <14 days (HR 13.9; p ¼ 0.007), and BI <30 (HR 2.76; p ¼ 0.049) were the counterparts for females. Conclusions: Previous vertebral fractures and BI <30 were the predictive variables of mortality for male patients, and BMI <18.5 kg/m 2 , TCCI 5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality.

Predictive factors of non-treatment and non-persistence to osteoporosis medication after fragility hip fractures at 3 years after discharge: a multicentre, prospective cohort study in the northern Kyushu district of Japan

“…These factors would have precluded adequate medical visits after treatment for FHF, resulting in an extremely low osteoporosis medication rate. Moreover, in our previous study, patients with low independence at discharge from the hospital after FHF treatment had a significantly lower survival rate after 1 year of fracture [16]. Therefore, after FHF treatment, active rehabilitation and improvement of the general conditions should be considered to increase the level of patient independence as much as possible.…”

“…The exclusion criteria included high-energy trauma and pathological fractures. As described in our previous study [1,16], to construct the FHF registry, the clinical data of eligible patients were submitted by each participating hospital to the data centre at the Kyushu University Hospital via the Clinical Research Internet Network (CRIN-Q) developed by the Kyushu University Hospital. Our 17 affiliated hospitals are all general hospitals with multiple departments and acute care that mainly provide surgical treatment for FHF.…”

“…In univariable and multivariable analyses, each variable was categorised as follows, according to the previous report [16]. Age was categorised as 60 ≤ age < 75 years, 75 ≤ age < 85 years, and age ≥ 85 years.…”

“Take action for bone health”

“…A study aiming to identify predictors of 1-year mortality in FHF patients showed that previous vertebral fracture and Barthel Index (BI) < 30 were found to increase risk of death for male patients. 7 Meanwhile, BMI < 18.5 kg/m 2 , Total Charlson Comorbidity Index (TCCI) of 5, smoking history, length of stay (LOS) < 14 days, and BI < 30 were the risk factors for female patients. 7 Fracture Liaison Service (FLS) is a coordinated multidisciplinary program, targeting the facilities available under the healthcare system, to prevent secondary fracture.…”

“…7 Meanwhile, BMI < 18.5 kg/m 2 , Total Charlson Comorbidity Index (TCCI) of 5, smoking history, length of stay (LOS) < 14 days, and BI < 30 were the risk factors for female patients. 7 Fracture Liaison Service (FLS) is a coordinated multidisciplinary program, targeting the facilities available under the healthcare system, to prevent secondary fracture. To date, there are one hundred and thirty-five FLS from thirteen countries/regions in Asia Pacific mapped on the "Capture the Fracture CtF" Map of Best Practice.…”