Prognostic Factors for All-Cause Mortality in Thai Patients with Fragility Fracture of Hip: Comorbidities and Laboratory Evaluations

Abstract

Background and Objectives: Although the types of comorbidities and laboratory evaluations are major factors associated with mortality after hip fractures, there have been no studies of the association of these factors and mortality in Thai hip-fracture patients. This study aimed to identify prognostic factors associated with mortality after a hip fracture in the Thai population, including types of comorbidities, treatment-related factors, and laboratory evaluations. Materials and Methods: This five-year retrospective study was conducted in a tertiary care hospital in Thailand. A total of 775 Thai patients who had been admitted with a hip fracture resulting from a simple fall were identified using the International Classification of Disease 10 codes, and a review of their medical charts was conducted. Associations between general factors, comorbidities, laboratory evaluations, treatment factors including type of treatment, and time to death were analyzed using the Cox proportional hazard regression and the hazard ratio (HR). Results: The overall mortality rate of hip fracture patients was 13.94%. Independent prognostic factors found to be significantly associated with mortality were nonoperative treatment (HR = 3.29, p < 0.001), admission glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 (HR = 3.40, p < 0.001), admission hemoglobin concentration <10 g/dL. (HR = 2.31, p < 0.001), chronic obstructive pulmonary disorder (HR = 2.63, p < 0.001), dementia or Alzheimer’s disease (HR = 4.06, p < 0.001), and active malignancy (HR = 6.80, p < 0.001). Conclusion: The types of comorbidities and laboratory evaluation findings associated with mortality in Thai patients with hip fractures include chronic obstructive pulmonary disorder, dementia or Alzheimer’s disease, active malignancy, admission GFR < 30 mL/min/1.73 m2, and admission hemoglobin concentration <10 g/dL. The risks of mortality for Thai hip-fracture patients with these comorbidities or laboratory evaluation findings were 2.5, 4, 7, 3.5, and 2.5 times higher, respectively, than patients without those factors.

Preoperative Correction of Low Hemoglobin Levels Can Reduce 1-Year All-Cause Mortality in Osteoporotic Hip Fracture Patients: A Retrospective Observational Study

“…Preoperative anemia has been reported to be associated with an increased risk of morbidity and mortality in osteoporotic hip fracture patients, particularly those with hemoglobin <10 g/dL. 10 , 14 The anemia can be the result of trauma-induced blood loss, iron deficiency, anemia from chronic comorbidities or, in the elderly, bone marrow dysfunction. However, there is currently no standard recommendation regarding who should have anemia correction by transfusion before hip fracture surgery, when such a transfusion should be administered and there is no standard cutoff values used to define the preoperative anemia.…”

“…The exclusion criteria were mentioned in our previous publication. 10 In brief, patients with bilateral hip fracture, previous hip fracture, more than one area of fractures, pathological hip fractures or high energy mechanism fractures were excluded. Data retrieved included basic demographics, underlying medical illness, type of fracture, type of surgery, American Association of Anesthesiologist (ASA) score 19 and time to operation.…”

“… 13 In addition, admission hemoglobin levels in the anemic range (<10 g/dL) have been reported to be a strong predictor of increased mortality risk following hip fracture. 10 , 14 In addition to an increased in mortality rate, anemia in hip fracture patients has been reported to be related to increased transfusion rates, hospital re-admission and poorer functional outcomes regardless of the severity of the anemia. 15 , 16 Tests for hemoglobin levels prior to hip fracture surgery are widely available, easy to interpret and inexpensive.…”

Prognostic Factors of 1-Year Postoperative Functional Outcomes of Older Patients with Intertrochanteric Fractures in Thailand: A Retrospective Cohort Study

“…Admission hemoglobin concentration has been extensively studied and was consistently reported as prognostic factors for functional outcomes and mortality in patients with hip fracture [ 21 ]. Based on our results, we recommended that orthopedists should maintain the preoperative Hb level greater than 10 g/dL to improve the postoperative functional recovery [ 13 ].…”

“…For avoiding violating the linearity assumption during modeling and interpretability of results, all continuous data were categorized using previously reported cut off points: age less than 80 years [ 19 ], preinjury new mobility score (NMS) more than 4 [ 20 ], Hb at least 10 g/dL [ 21 ], CCI below 5 [ 16 ], albumin not lower than 3 mg/L, the lateral wall thickness at least 20.5 mm [ 18 ], the neck-shaft angle at least 130° [ 7 ], lateral displacement less than 6 mm, posterior displacement less than 7 mm [ 7 , 9 ], CalTAD less than 25 mm [ 7 ], Parker’s ratio less than 40% [ 10 ], time to surgery less than 3 days [ 22 ], hospital stay less than 2 weeks [ 23 ]. A good ambulatory status at the discharge time was categorized into two groups based on the consensus of two senior authors (TA and DP): those who could walk with or without gait aids (an NMS of at least 2) and those who could not [ 24 ].…”