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Risk Factors Correlated with Post-operative Mortality for Hip Fracture Surgery in the Elderly: A Population-based Approach

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Abstract

Objectives: To estimate the effect of waiting time for surgery and volume of surgical activity on mortality in patients with hip fracture and to compare risk-adjusted outcomes between hospitals providing surgery for such patients. Design: Retrospective cohort study. Setting: Friuli Venezia Giulia, Italy. Participants: A total of 6,629 elderly people who underwent surgery for hip fracture between 1st January 1996 and 31th December 2000. Main outcome measures: In-hospital, 6-month and 1-year mortality rate Results: In-hospital mortality rate was 5.4%. At six months, the mortality rate was 20.0%, and at 1 year 25.3%. Age, male sex, and comorbidity were significant predictors of mortality. Logistic regression analysis indicated that, after controlling for main patients risk factors and taking into account the hospital level variability, there was no significant association between increase in mortality rate and more than 1 day of waiting time for surgery (OR 0.90; 95% CI 0.58–1.40 for in-hospital mortality). One hospital had a significantly higher mortality rate than the others; high hospital volume for hip fracture surgery was associated with worse outcomes (OR 1.57; 95% CI 1.38–1.78 for in-hospital mortality). Mortality after hip fracture decreased significantly from 1996 to 2000 (OR 0.85; 95% CI 0.80–0.90). Conclusions: Longer waiting time for surgery was not associated with mortality after adjusting for patient risk factors, and taking into account hospital level variability. Hospital level variability was statistically significant, and was partially explained by the total volume of hospital surgical activity. The decrease in mortality between 1996 and 2000 was confirmed by multivariate models.

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References

  1. SJ Jacobsen J Goldberg TP Miles JA Brody W Stiers AA Rimm (1992) ArticleTitleRace and sex differences in mortality following fracture of the hip Am J Public Health 82 1147–1150 Occurrence Handle1636840 Occurrence Handle1:STN:280:By2A2czpsFU%3D

    PubMed  CAS  Google Scholar 

  2. P Kannus J Parkkari H Sievanen A Heinonen I Vuori M Jarvinen (1996) ArticleTitleEpidemiology of hip fractures Bone 18 57S–63S Occurrence Handle8717549 Occurrence Handle1:STN:280:BymA2M3lt1c%3D

    PubMed  CAS  Google Scholar 

  3. MC Hochberg J Williamson EA Skinner J Guralnik JD Kasper LP Fried (1998) ArticleTitleThe prevalence and impact of self−reported femur fracture in elderly community−dwelling women: The women’s health and aging study Osteoporos Int 8 385–389 Occurrence Handle10.1007/s001980050079 Occurrence Handle10024910 Occurrence Handle1:STN:280:DyaK1M7kvFSnuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. WJ Gillespie (2001) ArticleTitleExtracts from clinical evidence: Hip fracture Br Med J 322 968–975 Occurrence Handle1:STN:280:DC%2BD3M3it1Sisg%3D%3D

    CAS  Google Scholar 

  5. LJ Melton SuffixII (1993) ArticleTitleHip fractures: A worldwide problem today and tomorrow Bone 14 S1–S8 Occurrence Handle10.1016/8756-3282(93)90341-7 Occurrence Handle8110512

    Article  PubMed  Google Scholar 

  6. WJ Boyce MP Vessey (1985) ArticleTitleRising incidence of fracture of the proximal femur Lancet 1 150–151 Occurrence Handle2857223 Occurrence Handle1:STN:280:BiqC3cbovFI%3D

    PubMed  CAS  Google Scholar 

  7. FD Wolinsky JF Fitzgerald TE Stump (1997) ArticleTitleThe effect of hip fracture on mortality, hospitalization and functional status: A prospective study Am J Public Health 87 398–403 Occurrence Handle9096540 Occurrence Handle1:STN:280:ByiB2M%2FosFM%3D

    PubMed  CAS  Google Scholar 

  8. AH Myers EG Robinson ML Natta ParticleVan JD Michelson K Collins SP Baker (1991) ArticleTitleHip fractures among the elderly: Factors associated with in-hospital mortality Am J Epidemiol 134 1128–1137 Occurrence Handle1746523 Occurrence Handle1:STN:280:By2D1c7ntlU%3D

    PubMed  CAS  Google Scholar 

  9. RA Marottoli LF Berkman L Leo-Summers LM Cooney (1994) ArticleTitlePredictors of mortality and institutionalisation after hip fracture: The New Haven EPESE Cohort Am J Public Health 84 1807–1812 Occurrence Handle7977922 Occurrence Handle1:STN:280:ByqD28fls1c%3D Occurrence Handle10.2105/AJPH.84.11.1807

    Article  PubMed  CAS  Google Scholar 

  10. EM Holt RA Evans CJ Hindley JW Metcalfe (1994) ArticleTitle1000 femoral neck fractures: The effect of pre-injury mobility and surgical experience on outcome Injury 25 91–95 Occurrence Handle10.1016/0020-1383(94)90109-0 Occurrence Handle8138305 Occurrence Handle1:STN:280:ByuC1cnitlM%3D

    Article  PubMed  CAS  Google Scholar 

  11. L Forsen AJ Sogaard HE Meyer T Edna B Kopjar (1999) ArticleTitleSurvival after hip fracture: Short- and long-term excess mortality according to age and gender Osteoporos Int 10 IssueID1 73–78 Occurrence Handle10501783 Occurrence Handle1:STN:280:DyaK1MvjtFKhtg%3D%3D

    PubMed  CAS  Google Scholar 

  12. HE Meyer A Tverdal JA Falch JI Pedersen (2000) ArticleTitleFactors associated with mortality after hip fracture Osteoporos Int 11 IssueID3 228–32 Occurrence Handle10.1007/s001980050285 Occurrence Handle10824238 Occurrence Handle1:STN:280:DC%2BD3c3osVamsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  13. M Cree CL Soskolne E Belseck et al. (2000) ArticleTitleMortality and institutionalization following hip fracture J Am Geriatr Soc 48 IssueID3 283–288 Occurrence Handle10733054 Occurrence Handle1:STN:280:DC%2BD3c7psFWqsA%3D%3D

    PubMed  CAS  Google Scholar 

  14. EL Hannan J Magaziner JJ Wang et al. (2001) ArticleTitleMortality and locomotion 6 months after hospitalization for hip fracture: Risk factors and risk-adjusted hospital outcomes JAMA 285 IssueID21 2736–2742 Occurrence Handle10.1001/jama.285.21.2736 Occurrence Handle11386929 Occurrence Handle1:STN:280:DC%2BD3MzltVChuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  15. JP Grimes PM Gregory H Noveck MS Butler JL Carson (2002) ArticleTitleThe effects of time to surgery on mortality and morbidity in patients following hip fracture Am J Med 112 IssueID9 702–709 Occurrence Handle10.1016/S0002-9343(02)01119-1 Occurrence Handle12079710

    Article  PubMed  Google Scholar 

  16. MJ Goldacre SE Roberts D. Yeates (2002) ArticleTitleMortality after admission to hospital with fractured neck of femur: Database study Br Med J 325 868–869

    Google Scholar 

  17. Scottish Intercollegiate Guidelines Network (SIGN). Management of Elderly People with Fractured Femur: A National Clinical Guideline. SIGN, 1997

  18. LM March AC Chamberlain ID Cameron et al. (1999) ArticleTitleHow best to fix a broken hip. Fractured neck of femur health outcomes project team Med J Aust 170 IssueID10 489–494 Occurrence Handle10376027 Occurrence Handle1:STN:280:DyaK1MzgsVeitw%3D%3D

    PubMed  CAS  Google Scholar 

  19. V Ho BH Hamilton LL Roos (2000) ArticleTitleMultiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada Health Serv Res 34 IssueID7 1499–518 Occurrence Handle10737450 Occurrence Handle1:STN:280:DC%2BD3c7pvFOisw%3D%3D

    PubMed  CAS  Google Scholar 

  20. GM Orosz J Magaziner EL Hannan et al. (2004) ArticleTitleAssociation of timing of surgery for hip fracture and patient outcomes JAMA 291 IssueID14 1738–1743 Occurrence Handle10.1001/jama.291.14.1738 Occurrence Handle15082701 Occurrence Handle1:CAS:528:DC%2BD2cXjt1WrtLs%3D

    Article  PubMed  CAS  Google Scholar 

  21. BH Hamilton V Ho (1998) ArticleTitleDoes practice make perfect? Examining the relationship between hospital surgical volume and outcomes for femur fracture patients in Quebec Med Care 36 IssueID6 892–903 Occurrence Handle10.1097/00005650-199806000-00012 Occurrence Handle9630130 Occurrence Handle1:STN:280:DyaK1c3pt1SrsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  22. RG Hughes DW Garnick HS Luft SJ McPhee SS Hunt (1988) ArticleTitleHospital volume and patient outcomes. The case of␣femur fracture patients Med Care 26 IssueID11 1057–1067 Occurrence Handle3185017 Occurrence Handle1:STN:280:BiaD3sfms1M%3D

    PubMed  CAS  Google Scholar 

  23. AB Flood WR Scott W Ewy (1984) ArticleTitleDoes practice make perfect? Part 1: The relation between hospital volume and outcomes for selected diagnostic categories Med Care 22 98–114 Occurrence Handle6700280 Occurrence Handle1:STN:280:BiuC2c%2Fks1E%3D

    PubMed  CAS  Google Scholar 

  24. EA Halm C Lee MR Chassin (2002) ArticleTitleIs volume related to outcome in health care? A systematic review and methodologic critique of the literature Ann Intern Med. 137 IssueID6 511–520 Occurrence Handle12230353

    PubMed  Google Scholar 

  25. NHS Centre for Reviews and Dissemination, University of York. Hospital volume and health care outcomes, costs and patient access. Effective Health Care Bull 1996; 2: 1–16

    Google Scholar 

  26. M Sturkenboom F Romano G Simon et al. (2002) ArticleTitleThe iatrogenic costs of NSAID therapy: A population study Arthr Rheum 47 132–140 Occurrence Handle10.1002/art.10268

    Article  Google Scholar 

  27. ME Charlson P Pompei KL Ales CR MacKenzie (1987) ArticleTitleA new method of classifying prognostic comorbidity in longitudinal studies: Development and validation J Chronic Dis 40 IssueID5 373–383 Occurrence Handle10.1016/0021-9681(87)90171-8 Occurrence Handle3558716 Occurrence Handle1:STN:280:BiiC28nlsVc%3D

    Article  PubMed  CAS  Google Scholar 

  28. RA Deyo DC Cherkin MA Ciol (1992) ArticleTitleAdapting a clinical comorbidity index for use with ICD-9-CM administrative databases J Clin Epidemiol 45 IssueID6 613–619 Occurrence Handle10.1016/0895-4356(92)90133-8 Occurrence Handle1607900 Occurrence Handle1:STN:280:By2A3c%2FjvFY%3D

    Article  PubMed  CAS  Google Scholar 

  29. DH Hosmer S Lemeshow (1989) Applied Logistic Regression John Wiley & Sons New York

    Google Scholar 

  30. PJ Diggle SL Zeger KY Liang (1994) Analysis of Longitudinal Data Clarendon Press Oxford (USA)

    Google Scholar 

  31. AV Diez Roux (2002) ArticleTitleA glossary for multilevel analysis J Epidemiol Community Health 56 588–594 Occurrence Handle12118049 Occurrence Handle1:STN:280:DC%2BD38znt1Gisw%3D%3D

    PubMed  CAS  Google Scholar 

  32. CJ Todd CJ Freeman C Camilleri-Ferante et al. (1995) ArticleTitleDifferences in mortality after fracture of hip: The East Anglian audit Br Med J 310 904–908 Occurrence Handle1:STN:280:ByqB3srjslc%3D

    CAS  Google Scholar 

  33. SE Roberts MJ Goldacre (2003) ArticleTitleTime trends and demography of mortality after fractured neck of femur in an English population, 1968–98: Database study Br Med J 327 771–775

    Google Scholar 

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Authors and Affiliations

  1. Agenzia Regionale della Sanità del Friuli Venezia Giulia, piazzale S. Maria della Misericordia 15, Udine, 33100, Italy

    Antonella Franzo, Carlo Francescutti & Giorgio Simon

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  1. Antonella Franzo
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  2. Carlo Francescutti
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  3. Giorgio Simon
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Franzo, A., Francescutti, C. & Simon, G. Risk Factors Correlated with Post-operative Mortality for Hip Fracture Surgery in the Elderly: A Population-based Approach. Eur J Epidemiol 20, 985–991 (2005). https://doi.org/10.1007/s10654-005-4280-9

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