The mortality burden in patients with hip fractures and dementia

Abstract

Purpose Dementia is strongly associated with postoperative death in patients subjected to hip fracture surgery. Nevertheless, there is a distinct lack of research investigating the cause of postoperative mortality in patients with dementia. This study aims to investigate the distribution and the risk of cause-specific postoperative mortality in patients with dementia compared to the general hip fracture population. Methods All adults who underwent emergency hip fracture surgery in Sweden between 1/1/2008 and 31/12/2017 were considered for inclusion. Pathological, conservatively managed fractures, and reoperations were excluded. The database was retrieved by cross-referencing the Swedish National Quality Registry for Hip Fracture patients with the Swedish National Board of Health and Welfare quality registers. A Poisson regression model was used to determine the association between dementia and all-cause as well as cause-specific 30-day postoperative mortality. Results 134,915 cases met the inclusion criteria, of which 20% had dementia at the time of surgery. The adjusted risk of all-cause 30-day postoperative mortality was 67% higher in patients with dementia after hip fracture surgery compared to patients without dementia [adj. IRR (95% CI): 1.67 (1.60–1.75), p < 0.001]. The risk of cause-specific mortality was also higher in patients with dementia, with up to a sevenfold increase in the risk cerebrovascular mortality [adj. IRR (95% CI): 7.43 (4.99–11.07), p < 0.001]. Conclusions Hip fracture patients with dementia have a higher risk of death in the first 30 days postoperatively, with a substantially higher risk of mortality due to cardiovascular, respiratory, and cerebrovascular events, compared to patients without dementia.

Early Detection of Pneumonia with the Help of Dementia in Geriatric Hip Fracture Patients

“…Patients with advanced dementia and hip fracture or pneumonia had a relatively poor prognosis. More explicitly, 6‐month mortality was up 50% 8 and dementia patients with hip fracture suffered from a higher risk of postoperative mortality, as compared with patients without dementia 1,2,9–11 . Pneumonia is also the most common complication of hip fractures 12 .…”

β-Adrenergic blockade in patients with dementia and hip fracture is associated with decreased postoperative mortality

“…Approximately 20% of the hip fracture patients have dementia, which has been strongly linked to worse outcomes [2][3][4][5][6], with a significantly higher risk of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia [7]. In the last 15 years, two meta-analyses and a Cochrane review have been published on beta-blocker therapy and non-cardiac surgery, outlining its cardioprotective effects [25][26][27].…”

“…Furthermore, approximately 20% of hip fracture patients have dementia, a condition independently associated with an almost threefold increase in postoperative mortality risk [2][3][4][5][6]. These patients have a substantially higher incidence of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia [7]. The hyper-adrenergic state that follows a traumatic injury and subsequent surgery plays a role in these adverse outcomes [2,[8][9][10][11][12].…”

The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study

“…In general, the out-of-hours tend to be staffed by senior residents or junior specialists, with less access to more experienced surgeons than regular work hours; however, this also seems unlikely to be the cause of the discrepancy. According to the literature, except in rare circumstances, hip fracture surgery itself does not kill patients; they die due to cardiovascular, respiratory, or cerebrovascular events, among other causes [21,[45][46][47][48]. At most, these events can be attributable to the strain induced by the anesthesia, but even the time spent under anesthesia does not appear to be increased out-of-hours [49].…”

“…We were therefore unable adjust for the type of anesthesia used or other intraoperative variables. We also did not have any access to data regarding the duration of the surgical procedures, the rationale for patient-level decisions regarding operative timing, or the individual surgeon's experience; however, these are unlikely significant cofounders [21,[45][46][47][48][49].…”