Survival analysis after hip fracture: higher mortality than the general population and delayed surgery increases the risk at any time

Abstract

Purpose: To estimate survival curves in patients with hip fracture according to gender, age, type of fracture, and waiting time for surgery and to compare them with the life expectancy of the general population. The study hypothesis is that survival after hip fractures is significantly lower than in the general population, especially in cases that underwent delayed surgery, regardless of age and gender. Methods: A survival analysis study was designed and approved by our institutional ethics review board. All patients who were coded with a diagnosis of hip fracture from 2002 to 2018 were included in the study. A total of 1176 patients were included, and the median age was 81 years (18–105 years). Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who underwent surgery on time and those with surgical delays. An exponential multivariate regression model was estimated, and a hazard ratio (HR) was reported for age, gender, and wait time for surgery. A significance of 5% was used, and a confidence interval level of 95% was reported. Results: The Kaplan-Meier curves for delayed surgery (log-rank, p = 0.00) and the age group (log-rank, p = 0.00) were significantly different. Exponential regression estimated an HR 1.05 (1.05–1.07) for age, HR 1.80 (1.51–2.13) for men, and HR 1.93 (1.61–2.31) for each day of wait for surgery. Conclusions: The 2 significant findings of this study are that hip fracture patients over 40 years old have a higher risk of dying at any time compared to the general population and that the waiting time for surgery (a modifiable factor) decreases survival rates at any time.

A 2-year follow-up of a novel Fracture Liaison Service: can we reduce the mortality in elderly hip fracture patients? A prospective cohort study

“…Moreover, patients included in the FLS protocol in our department had an adjusted 1-year mortality hazard ratio lower than those individuals treated before its implementation. A recent survival analysis showed that hip fracture patients had a lower life expectancy compared to the general population and their high risk of dying remained constant [ 10 ]. A larger study also showed that hip fracture is associated with excess short- and long-term all-cause mortality in both sexes [ 11 ].…”

Surgical Management and Outcomes following Pathologic Hip Fracture—Results from a Propensity Matching Analysis of the Registry for Geriatric Trauma of the German Trauma Society

“…While surgical treatment was performed in approximately 80% of patients with osteoporotic hip fractures within the first 24 h, this was the case in only approximately 65% of patients with a pathologic fracture. While delay in time to surgery is known to be directly correlated with mortality in patients with osteoporotic hip fractures, the delay in patients suffering from pathologic femoral fractures was not associated with an increased mortality rate during the acute hospital stay in the present analysis [ 25 ]. Therefore, it must be presumed that pathologic hip fractures in geriatric patients are—other than fractures in osteoporosis-related hips—not a typical frailty marker, as is already known from other hip fracture types, e.g., periprosthetic femoral fractures [ 26 ].…”

Application of a deep learning algorithm in the detection of hip fractures

“… 14 Delayed diagnosis of hip fractures and resultant prolonged time to hospital admission and corrective surgery have been demonstrated to increase patient mortality and morbidity. 15 , 16 , 17 …”