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Mortality rates and risk factors after low-trauma hip fracture in the largest university center in Romania

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Abstract

Summary

We calculated in-hospital, 30-day, and 1-year mortality rates and analyzed potential mortality risk factors in 2742 patients with low-trauma hip fractures. We found a high mortality rate at 30 days and 1 year after hip fracture. The high mortality can be explained by a very high number of conservatively treated fractures.

Purpose

Data on mortality after low-trauma hip fracture in Romania is scarce and comes from a single-hospital study. Our aim was to calculate mortality rates and risk factors in all patients admitted for low-trauma hip fracture in the largest university medical center of Romania.

Methods

We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest, Romania, and surrounding Ilfov County and calculated the crude in-hospital, 30-day, and 1-year mortality rates after low-trauma hip fractures. A number of potential clinical risk factors for mortality were evaluated.

Results

We analyzed 2742 low-trauma hip fractures. The in-hospital, 30-day, and 1-year all-cause mortality rates were 4.26% (n=117), 9.59% (n=263), and 29.72% (n=815) respectively. Four hundred and fifty (16.41%) fractures were managed conservatively with a 1-year mortality HR of 3.05 (p<0.001) compared to surgically treated fractures. The 1-year mortality rate in conservatively treated fractures was 56.44% compared to 24.47% in surgically treated fractures. Age, male sex, length of stay in hospital, day of surgery, post-surgical complications, and late surgery were significantly associated (p<0.001) with mortality after hip fracture. The lowest 1-year mortality rate was in surgically treated patients with a length of stay in hospital between 6 and 10 days.

Conclusion

We found a high mortality rate at 30 days and 1 year after low-trauma hip fracture. The high mortality rates can be attributable, in part, to the high number of conservatively treated fractures.

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References

  1. Abrahamsen B, Van Staa T, Ariely R et al (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650. https://doi.org/10.1007/s00198-009-0920-3

    Article  CAS  PubMed  Google Scholar 

  2. Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, de Laet C, Jönsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42. https://doi.org/10.1007/s00198-003-1490-4

    Article  CAS  PubMed  Google Scholar 

  3. Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390. https://doi.org/10.7326/0003-4819-152-6-201003160-00008

    Article  PubMed  PubMed Central  Google Scholar 

  4. Johansen A, Golding D, Brent L, Close J, Gjertsen JE, Holt G, Hommel A, Pedersen AB, Röck ND, Thorngren KG (2017) Using national hip fracture registries and audit databases to develop an international perspective. Injury 48:2174–2179. https://doi.org/10.1016/j.injury.2017.08.001

    Article  PubMed  Google Scholar 

  5. Mundi S, Pindiprolu B, Simunovic N, Bhandari M (2014) Similar mortality rates in hip fracture patients over the past 31 years. Acta Orthop 85:54–59. https://doi.org/10.3109/17453674.2013.878831

    Article  PubMed  PubMed Central  Google Scholar 

  6. Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, Eriksson S, Wilsgaard T, Jørgensen L, Ahmed LA, Schöttker B, Brenner H, Bellavia A, Wolk A, Kubinova R, Stegeman B, Bobak M, Boffetta P, Trichopoulou A (2017) Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med 281:300–310. https://doi.org/10.1111/joim.12586

    Article  CAS  PubMed  Google Scholar 

  7. Medin E, Goude F, Melberg HO, Tediosi F, Belicza E, Peltola M, on behalf of the EuroHOPE study group (2015) European regional differences in all-cause mortality and length of stay for patients with hip fracture. Heal Econ (United Kingdom) 24:53–64. https://doi.org/10.1002/hec.3278

    Article  Google Scholar 

  8. Downey C, Kelly M, Quinlan JF (2019) Changing trends in the mortality rate at 1-year post hip fracture - a systematic review. World J Orthop 10:166–175. https://doi.org/10.5312/wjo.v10.i3.166

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jürisson M, Raag M, Kallikorm R, Lember M, Uusküla A (2017) The impact of hip fracture on mortality in Estonia: a retrospective population-based cohort study. BMC Musculoskelet Disord 18:1–10. https://doi.org/10.1186/s12891-017-1606-1

    Article  Google Scholar 

  10. Tay E (2016) Hip fractures in the elderly: operative versus nonoperative management. Singap Med J 57:178–181. https://doi.org/10.11622/smedj.2016071

    Article  Google Scholar 

  11. Smith T, Pelpola K, Ball M, Ong A, Myint PK (2014) Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 43:464–471. https://doi.org/10.1093/ageing/afu065

    Article  PubMed  Google Scholar 

  12. Poenaru DV, Prejbeanu R, Iulian P, Haragus H, Popovici E, Golet I, Vermesan D (2014) Epidemiology of osteoporotic hip fractures in Western Romania. Int Orthop 38:2329–2334. https://doi.org/10.1007/s00264-014-2407-x

    Article  PubMed  Google Scholar 

  13. Belmont PJ, Garcia EJ, Romano D et al (2014) Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg 134:597–604. https://doi.org/10.1007/s00402-014-1959-y

    Article  PubMed  Google Scholar 

  14. Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV (2011) Risk factors for in-hospital post-hip fracture mortality. Bone. 49:553–558. https://doi.org/10.1016/j.bone.2011.06.002

    Article  PubMed  Google Scholar 

  15. Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ (2015) Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Jt J 97-B:246–251. https://doi.org/10.1302/0301-620X.97B2.35248

    Article  CAS  Google Scholar 

  16. No authors listed (2019) National hip fracture database annual report. In: Natl. Hip Fract. Database. https://www.nhfd.co.uk/20/hipfractureR.nsf/docs/2019Report

  17. Sheehan KJ, Sobolev B, Chudyk A, Stephens T, Guy P (2016) Patient and system factors of mortality after hip fracture: a scoping review. BMC Musculoskelet Disord 17:166. https://doi.org/10.1186/s12891-016-1018-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Silber JH, Williams SV, Krakauer H, Schwartz JS (1992) Hospital and patient characteristics associated with death after surgery: a study of adverse occurrence and failure to rescue. Med Care 30:615–629. https://doi.org/10.1097/00005650-199207000-00004

    Article  CAS  PubMed  Google Scholar 

  19. Sheehan KJ, Guerrero EM, Tainter D, Dial B, Milton-Cole R, Blair JA, Alexander J, Swamy P, Kuramoto L, Guy P, Bettger JP, Sobolev B (2019) Prognostic factors of in-hospital complications after hip fracture surgery: a scoping review. Osteoporos Int 30:1339–1351. https://doi.org/10.1007/s00198-019-04976-x

    Article  CAS  PubMed  Google Scholar 

  20. Prommik P, Kolk H, Sarap P, Puuorg E, Harak E, Kukner A, Pääsuke M, Märtson A (2019) Estonian hip fracture data from 2009 to 2017: high rates of non­operative management and high 1-year mortality. Acta Orthop 90:159–164. https://doi.org/10.1080/17453674.2018.1562816

    Article  PubMed  PubMed Central  Google Scholar 

  21. Neuman MD, Fleisher LA, Even-Shoshan O, Mi L, Silber JH (2010) Nonoperative care for hip fracture in the elderly: the influence of race, income, and comorbidities. Med Care 48:314–320. https://doi.org/10.1097/MLR.0b013e3181ca4126

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cram P, Yan L, Bohm E, Kuzyk P, Lix LM, Morin SN, Majumdar SR, Leslie WD (2017) Trends in operative and nonoperative hip fracture management 1990–2014: a longitudinal analysis of Manitoba administrative data. J Am Geriatr Soc 65:27–34. https://doi.org/10.1111/jgs.14538

    Article  PubMed  Google Scholar 

  23. Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM (2014) Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med 174:1273–1280. https://doi.org/10.1001/jamainternmed.2014.2362

    Article  PubMed  PubMed Central  Google Scholar 

  24. Parker M, Handoll H, Bhargava A (2000) Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd000337

  25. Chlebeck JD, Birch CE, Blankstein M, Kristiansen T, Bartlett CS, Schottel PC (2019) Nonoperative geriatric hip fracture treatment is associated with increased mortality. J Orthop Trauma 33:346–350. https://doi.org/10.1097/BOT.0000000000001460

    Article  PubMed  Google Scholar 

  26. Nikkel LE, Kates SL, Schreck M, Maceroli M, Mahmood B, Elfar JC (2015) Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study. BMJ. https://doi.org/10.1136/bmj.h6246

  27. Nordströ P, Gustafson Y, Michaëlsson K, Nordström A (2015) Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ. 350. https://doi.org/10.1136/bmj.h696

  28. Dubljanin-Raspopović E, Marković-Denić L, Marinković J, Nedeljković U, Bumbaširević M (2013) Does early functional outcome predict 1-year mortality in elderly patients with hip fracture? Hip. Clin Orthop Relat Res 471:2703–2710. https://doi.org/10.1007/s11999-013-2955-1

    Article  PubMed  PubMed Central  Google Scholar 

  29. Weller I, Wai EK, Jaglal S, Kreder HJ (2005) The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Jt Surg - Ser B 87-B:361–366. https://doi.org/10.1302/0301-620X.87B3.15300

    Article  Google Scholar 

  30. Taylor DH, Whellan DJ, Sloan FA (1999) Effects of admission to a teaching hospital on the cost and quality of care for medicare beneficiaries. N Engl J Med 340:293–299. https://doi.org/10.1056/nejm199901283400408

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Prof. Stefan Cristea (Pantelimon Clinical Emergency Hospital), Lect. Florin Bica (Bagdasar-Arseni Clinical Emergency Hospital Bucharest), Dr. Lucian Diaconescu (Sf. Ioan Clinical Emergency Hospital Bucharest), Prof. Horia Orban (ELIAS Emergency University Hospital), Prof. Gheorghe Adrian Barbilian (Carol Davila Military Central Hospital Bucharest), Prof. Ioan Cristian Stoica (Clinical Hospital of Orthopedics, Traumatology and Osteoarticular TBC Bucharest), Dr. Lucian Stanciu (Ilfov County Emergency Clinical Hospital), Dr. Daniel Ioniță (CF-2 Clinical Hospital Bucharest), and Conf. Rodica Marinescu (Colentina Clinical Hospital) for their support and assistance with data gathering.

Declarations

None.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania

    Ramona Dobre, Dan Alexandru Niculescu & Catalina Poiana

  2. Department of Endocrinology, National Institute of Endocrinology CI Parhon, 34-38 Aviatorilor blvd, 011863, Bucharest, Romania

    Ramona Dobre, Dan Alexandru Niculescu & Catalina Poiana

  3. Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 169 Splaiul Independenței, 050098, Bucharest, Romania

    Catalin Cirstoiu

  4. Bucharest Emergency University Hospital, 169 Splaiul Independenței, 050098, Bucharest, Romania

    Catalin Cirstoiu

  5. Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, 8 Calea Floreasca, 014461, Bucharest, Romania

    Gheorghe Popescu

  6. Bucharest Clinical Emergency Hospital, 8 Calea Floreasca, 014461, Bucharest, Romania

    Gheorghe Popescu

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  1. Ramona Dobre
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Correspondence to Ramona Dobre.

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Dobre, R., Niculescu, D.A., Cirstoiu, C. et al. Mortality rates and risk factors after low-trauma hip fracture in the largest university center in Romania. Arch Osteoporos 16, 64 (2021). https://doi.org/10.1007/s11657-021-00934-5

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