Abstract
To identify determinants of mortality after hip fracture, we performed a multicenter, retrospective study of 390 Medicare beneficiaries. Independent predictors of 30-day mortality included a history of congestive heart failure (odds ratio [OR] 32; 95% confidence interval [CI] 5, 192), angina (OR 26; 95% CI 4, 184), or chronic pulmonary disease (OR 11; 95% CI 2, 62). Postoperative use of aspirin was- associated with a reduced risk of mortality (OR 0.24; 95% CI 0.08, 0.70). Cardiovascular events were the presumed cause of 63% of in-hospital deaths. Aspirin may have significant potential to reduce mortality in this population and deserves further study.
References
Myers AH, Robinson EG, Van Natta ML, Michelson JD, Collins K, Baker SP. Hip fractures among the elderly: factors associated with in-hospital mortality. Am J Epidemiol. 1991;134:1128–37.
Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg. 1994;76-A:751–8.
Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2:285–9.
Schrøder HM, Erlandsen M. Age and sex as determinants of mortality after hip fracture: 3,895 patients followed for 2.5–18.5 years. J Orthop Trauma. 1993;7:525–31.
Kenzora JE, McCarthy RE, Lowell JD, Sledge C. Hip fracture mortality: relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Rel Res. 1984;186:45–56.
Jencks SF, Wilensky GR. The Health Care Quality Improvement Initiative—a new approach to quality assurance in Medicare. JAMA. 1992;268:900–3.
Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin: overview of results of randomized trials in general, orthopedic, and urologic survey. N Engl J Med. 1988;318:1162–73.
Claget GP, Anderson FA, Heit J, Levine MN, Wheeler HB. Prevention of venous thromboembolism. Chest. 1995;108:312S-34S.
Anderson FA, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A, Patwardhan NA. Physician practices in the prevention of venous thromboembolism. Ann Intern Med. 1991;115:591–5.
Mossey JM, Mutran E, Knott K, Craik R. Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health. 1989;79:279–86.
Magaziner J, Simonsick EM, Kashner TM, Hebel JR. Kenzora JE. Survival experience of aged hip fracture patients. Am J Public Health. 1989;79:274–8.
Fitzgerald JF, Fagan LF, Tierney WM, Dittus RS. Changing patterns of hip fracture care before and after implementation of the prospective payment system. JAMA. 1987;258:218–21.
Willard JE, Lange RA, Hillis LD. The use of aspirin in ischemic heart disease. N Engl J Med. 1993;327:175–81.
Steering committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med. 1989;321:129–35.
Anonymous. Aspirin for prevention of myocardial infarction. Medical Lett. 1995;37:14–6.
Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy, I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81–106.
Krumholz HM, Radford MJ, Ellerbeck E, et al. Aspirin in the treatment of acute myocardial infection in elderly Medicare beneficiaries: patterns of use and outcomes. Circulation. 1995;92:2841–7.
MacMahon S, Rodgers A, Collins R, Farrell B. Antiplatelet therapy to prevent thrombosis after hip fracture: rationale for a randomised trial. J Bone Joint Surg Br. 1994;76-B:521–4.
Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy, III: reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. BMJ. 1994;308:235–46.
Imperiale TF, Speroff T. A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA. 1994;271:1780–5.
Author information
Authors and Affiliations
Additional information
Supported by the Iowa Foundation for Medical Care and the Health Care Financing Agency for which the authors worked.
The views expressed in this article are those of the authors and do not represent an official position of the Iowa Foundation for Medical Care or the Health Care Financing Agency.
Rights and permissions
About this article
Cite this article
Nettleman, M.D., Alsip, J., Schroder, M. et al. Predictors of mortality after acute hip fracture. J Gen Intern Med 11, 765–767 (1996). https://doi.org/10.1007/BF02598997
Issue Date:
DOI: https://doi.org/10.1007/BF02598997