Prospective cohort protocol examining the perioperative indicators for complications and early mortality following hip fracture surgery in the frail patient
Abstract:IntroductionThe primary aim is to validate earlier suggested risk factors and to find new associated risk factors for (30-day) mortality after a hip fracture in the frail population. The secondary aim is to determine the factors associated with perioperative complications. At last we want to develop and validate a more specific 30-day mortality prediction tool compared with the Nottingham Hip Fracture Score. The 30-day mortality prediction can help inform surgical risk and guide shared decision-making among pa… Show more
“…A detailed overview of the data collection and the standards of hip fracture treatment is available in the FAMMI study protocol. 17 The 30-day time frame was chosen based on the commonly used follow-up period by studies evaluating the association between perioperative mortality and a hip fracture. 8–10 Figure 1 Flow chart of included patients.…”
Purpose
The primary objective of this study was to identify new risk factors and to confirm previously reported risk factors associated with 30-day mortality after hip fracture surgery.
Patients and methods
A prospective hip fracture database was used to obtain data. In total, 3523 patients who underwent hip fracture surgery between 2011 and 2021 were included. Univariable and multivariable logistic regression was used to screen and identify candidate risk factors. Twenty-seven baseline factors and 16 peri-operative factors were included in the univariable analysis and 28 of those factors were included in multivariable analysis.
Results
8.6% of the patients who underwent hip fracture surgery died within 30 days after surgery. Prognostic factors associated with 30-day mortality after hip fracture surgery were as follows: age 90–100 years (OR = 4.7, 95% CI: 1.07–19.98, p = 0.041) and above 100 years (OR = 11.3, 95% CI: 1.28–100.26, p = 0.029), male gender (OR = 2.6, 95% CI: 1.97–3.33, p < 0.001), American Society of Anesthesiologists (ASA) 3 and ASA 4 (OR = 2.1, 95% CI: 1.44–3.14, p < 0.001), medical history of dementia (OR = 1.7, 95% CI: 1.25–2.36, p = 0.001), decreased albumin level (OR = 0.94, 95% CI: 0.92–0.97, p < 0.001), decreased glomerular filtration rate (GFR) (OR = 0.98, 95% CI: 0.98–0.99, p < 0.001), residential status of nursing home (OR = 2.1, 95% CI: 1.44–2.87, p < 0.001), higher Katz Index of Independence in Activities of Daily Living (KATZ-ADL) score (OR = 1.1, 95% CI: 1.01–1.16, p=0.018) and postoperative pneumonia (OR = 2.4, 95% CI: 1.72–3.38, p < 0.001).
Conclusion
A high mortality rate in patients after acute hip fracture surgery is known. Factors that are associated with an increased mortality are age above 90 years, male gender, ASA 3 and ASA 4, medical history of dementia, decreased albumin, decreased GFR, residential status of nursing home, higher KATZ-ADL score and postoperative pneumonia.
“…A detailed overview of the data collection and the standards of hip fracture treatment is available in the FAMMI study protocol. 17 The 30-day time frame was chosen based on the commonly used follow-up period by studies evaluating the association between perioperative mortality and a hip fracture. 8–10 Figure 1 Flow chart of included patients.…”
Purpose
The primary objective of this study was to identify new risk factors and to confirm previously reported risk factors associated with 30-day mortality after hip fracture surgery.
Patients and methods
A prospective hip fracture database was used to obtain data. In total, 3523 patients who underwent hip fracture surgery between 2011 and 2021 were included. Univariable and multivariable logistic regression was used to screen and identify candidate risk factors. Twenty-seven baseline factors and 16 peri-operative factors were included in the univariable analysis and 28 of those factors were included in multivariable analysis.
Results
8.6% of the patients who underwent hip fracture surgery died within 30 days after surgery. Prognostic factors associated with 30-day mortality after hip fracture surgery were as follows: age 90–100 years (OR = 4.7, 95% CI: 1.07–19.98, p = 0.041) and above 100 years (OR = 11.3, 95% CI: 1.28–100.26, p = 0.029), male gender (OR = 2.6, 95% CI: 1.97–3.33, p < 0.001), American Society of Anesthesiologists (ASA) 3 and ASA 4 (OR = 2.1, 95% CI: 1.44–3.14, p < 0.001), medical history of dementia (OR = 1.7, 95% CI: 1.25–2.36, p = 0.001), decreased albumin level (OR = 0.94, 95% CI: 0.92–0.97, p < 0.001), decreased glomerular filtration rate (GFR) (OR = 0.98, 95% CI: 0.98–0.99, p < 0.001), residential status of nursing home (OR = 2.1, 95% CI: 1.44–2.87, p < 0.001), higher Katz Index of Independence in Activities of Daily Living (KATZ-ADL) score (OR = 1.1, 95% CI: 1.01–1.16, p=0.018) and postoperative pneumonia (OR = 2.4, 95% CI: 1.72–3.38, p < 0.001).
Conclusion
A high mortality rate in patients after acute hip fracture surgery is known. Factors that are associated with an increased mortality are age above 90 years, male gender, ASA 3 and ASA 4, medical history of dementia, decreased albumin, decreased GFR, residential status of nursing home, higher KATZ-ADL score and postoperative pneumonia.
“…This study is an observational cohort study with real-time registration of patients in a prospective hip fracture database (FAMMI trial). 27 All consecutively admitted patients between 1 January 2018 and 11 January 2021 in two level II trauma teaching hospitals located in Rotterdam, the Netherlands, with fractures of the femoral neck and (sub)trochanteric area and an age of ≥ 65 years who were treated with osteosynthesis (i.e. cannulated screws, sliding hip screw, or cephalocondylar nail system) or prosthesis (i.e.…”
Aims Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize clinical outcomes after hip fracture surgery. This study aims to determine the influence of postponement of surgery due to non-medical reasons on clinical outcomes in acute hip fracture surgery. Methods This observational cohort study enrolled consecutively admitted patients with a proximal femoral fracture, for which surgery was performed between 1 January 2018 and 11 January 2021 in two level II trauma teaching hospitals. Patients with medical indications to postpone surgery were excluded. A total of 1,803 patients were included, of whom 1,428 had surgery < 24 hours and 375 had surgery ≥ 24 hours after admission. Results Prolonged total length of stay was found when surgery was performed ≥ 24 hours (median 6 days (interquartile range (IQR) 4 to 9) vs 7 days (IQR 5 to 10); p = 0.001) after admission. No differences in postoperative length of hospital stay nor in 30-day mortality rates were found. In subgroup analysis for time frames of 12 hours each, pressure sores and urinary tract infections were diagnosed more frequently when time to surgery increased. Conclusion Longer time to surgery due to non-medical reasons was associated with a higher incidence of postoperative pressure sores and urinary tract infections when time to surgery was more than 48 hours after admission. No association was found between time to surgery and 30-day mortality rates or postoperative length of hospital stay. Cite this article: Bone Joint J 2022;104-B(12):1369–1378.
“…Hip fracture in elderly patients is a health problem with high morbidity and mortality. Studies have found that mortality in hip fractures within 30 days is 5-13% and 1-year mortality is 22-30% (1). The incidence of coronary artery disease, heart failure, atrial fibrillation and stroke increases significantly in elderly patients.…”
ABSTRACT
Objective: Ischemic complications or massive bleeding are important perioperative complications in elderly patients using antithrombotic drugs. The need for blood product replacement, transfusion-related complications, prolonged stay in hospital and intensive care unit, and high mortality in the perioperative period can be seen. The aim of this study was to investigate the effects of long-term different antithrombotic therapies on morbidity and mortality in elderly patients undergoing surgery for hip fracture.
Materials and Methods: This retrospective cohort study included patients aged 65 years and older who underwent surgery for hip fracture between 2015 and 2018. Patients with no antithrombotic treatment (Group NonAT), warfarin (Group Warfarin), novel oral anticoagulants (Group NOACs), or dual antiplatelet therapy (Group DAPT) were compared in terms of major bleeding, deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) complications, length of hospital stay (LOS), ICU admission, and 30-day mortality.
Results: The study included 668 patients; demographic data in Group NonAT (n=442), Group Warfarin (n=59), Group NOACs (n=30) and Group DAPT(n=137) were similar. Major bleeding and red blood cell transfusion did not differ statistically between all groups. (p>0.05) The preoperative and postoperative Hb values of the patients were not statistically different between the groups (p>0.05). Mortality, only there was statistically significantly higher in the dual antiplatelet group than the non user group. (p0.05) However survival was statistically significant different (p
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