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Outcomes following surgical management of femoral neck fractures in elderly dialysis-dependent patients

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Proximal femur fractures are one of the most common fractures observed in dialysis-dependent patients. Given the large comorbidity burden present in this patient population, more information is needed regarding post-operative outcomes. The goal of this study was to assess morbidity and mortality following operative fixation of femoral neck fractures in the dialysis-dependent elderly.

Methods

The full set of medicare data from 2005 to 2014 was retrospectively analyzed. Elderly patients with femoral neck fractures were selected. Patients were stratified based on dialysis dependence. Post-operative morbidity and mortality outcomes were compared between the two populations. Adjusted odds were calculated to determine the effect of dialysis dependence on outcomes.

Results

A total of 320,629 patients met the inclusion criteria. Of dialysis-dependent patients, 1504 patients underwent internal fixation and 2662 underwent arthroplasty. For both surgical cohorts, dialysis dependence was found to be associated with at least 1.9 times greater odds of mortality within 1 and 2 years post-operatively. Blood transfusions within 90 days and infections within 2 years were significantly increased in the dialysis-dependent study cohort. Dialysis dependence alone did not contribute to increased mechanical failure or major medical complications.

Conclusion

Regardless of the surgery performed, dialysis dependence is a significant risk factor for major post-surgical morbidity and mortality after operative treatment of femoral neck fractures in this population. Increased mechanical failure in the internal fixation group was not observed. The increased risk associated with caring for this population should be understood when considering surgical intervention and counseling patients.

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Funding

There is no funding source for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Johns Hopkins Medical Center, Baltimore, MD, USA

    Varun Puvanesarajah, Raj Amin & Babar Shafiq

  2. Department of Orthopedic Surgery, University of Virginia, Box 800159 HSC, Charlottesville, VA, 22908, USA

    Rabia Qureshi, Hamid Hassanzadeh & Seth Yarboro

  3. Department of Orthopedic Surgery, George Washington Medical Center, Washington, DC, USA

    Ben Stein

Authors
  1. Varun Puvanesarajah
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  2. Raj Amin
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  3. Rabia Qureshi
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  4. Babar Shafiq
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  5. Ben Stein
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  6. Hamid Hassanzadeh
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  7. Seth Yarboro
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Corresponding author

Correspondence to Seth Yarboro.

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Conflict of interest

All authors declare that they have no conflict of interest. Dr. Hassanzadeh has received financial research support from Pfizer, consultancy fees from Nuvasive and research Grants from Orthofix

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Varun Puvanesarajah and Raj Amin are co-first authors.

Appendix

Appendix

See Table 4.

Table 4 ICD-9-CM and CPT codes for mechanical complications of internal fixation and hemiarthroplasty
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Puvanesarajah, V., Amin, R., Qureshi, R. et al. Outcomes following surgical management of femoral neck fractures in elderly dialysis-dependent patients. Arch Orthop Trauma Surg 138, 757–764 (2018). https://doi.org/10.1007/s00402-018-2898-9

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  • DOI: https://doi.org/10.1007/s00402-018-2898-9

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