Advertisement

International Orthopaedics

, Volume 37, Issue 11, pp 2119–2124 | Cite as

Predictors of early mortality after hip fracture surgery

  • Muhammad Asim KhanEmail author
  • Fahad Siddique Hossain
  • Iftikhar Ahmed
  • Nagarajan Muthukumar
  • Amr Mohsen
Original Paper

Abstract

Purpose

The aim of this study was to examine causes and potential risk factors for 30-day mortality after hip fracture surgery (HFS) at a high-volume tertiary-care hospital.

Methods

We retrospectively reviewed 467 patients who underwent HFS at our institution. Multivariate analysis was undertaken to identify potential predictors of early mortality.

Results

The 30-day mortality rate was 7.5 % (35/467). The most common causes of death were pneumonia (37.1 %, 13/35), acute coronary syndrome (31.4 %, 11/35) and sepsis (14.3 %, 5/35). Surgery after 48 hours of admission had a significantly higher 30-day mortality rate (11 % versus 4 %, p = 0.006). There was a significant difference in age (p = 0.034), admission source (p  < 0.001), preoperative haemoglobin (p < 0.001), walking ability (p  = 0.004), number of comorbidities (p  = 0.004) and pre-existing dementia (p  = 0.01), cardiac disease (p  < 0.001), chronic obstructive pulmonary disorder (COPD) (p  = 0.036) and renal failure (p  = 0.007) between the 30-day mortality group and the rest of the cohort. Surgical delay greater than 48 hours, admission source and pre-existing cardiac disease were identified as the strongest predictors of 30-day mortality.

Conclusion

Surgical delay is an important but avoidable determinant of early mortality after HFS. Respiratory and cardiac function needs to be optimised postoperatively with early intervention in patients with signs of cardiovascular compromise or infection.

Keywords

Trauma Hip fracture Neck of femur Co-morbidities 30-day mortality Risk factors 

Notes

Conflict of interest

None.

References

  1. 1.
    Hu F, Jiang C, Shen J, Tang P, Wang Y (2012) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43:676–685PubMedCrossRefGoogle Scholar
  2. 2.
    Parker MJ, Anand JK (1991) What is the true mortality of hip fractures? Public Health 105:443–446PubMedCrossRefGoogle Scholar
  3. 3.
    Pioli G, Barone A, Giusti A, Oliveri M, Pizzonia M, Razzano M, Palummeri E (2006) Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res 18:381–387PubMedCrossRefGoogle Scholar
  4. 4.
    Vestergaard P, Rejnmark L, Mosekilde L (2007) Has mortality after a hip fracture increased? J Am Geriatr Soc 55:1720–1726PubMedCrossRefGoogle Scholar
  5. 5.
    Beringer TR, Clarke J, Elliott JR, Marsh DR, Heyburn G, Steele IC (2006) Outcome following proximal femoral fracture in Northern Ireland. Ulster Med J 75:200–206PubMedGoogle Scholar
  6. 6.
    Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250PubMedCrossRefGoogle Scholar
  7. 7.
    Maxwell MJ, Moran CG, Moppett IK (2008) Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. Br J Anaesth 101:511–517PubMedCrossRefGoogle Scholar
  8. 8.
    Nettleman MD, Alsip J, Schrader M, Schulte M (1996) Predictors of mortality after acute hip fracture. J Gen Intern Med 11:765–767PubMedCrossRefGoogle Scholar
  9. 9.
    Talsnes O, Vinje T, Gjertsen JE, Dahl OE, Engesaeter LB, Baste V, Pripp AH, Reikeras O (2013) Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,210 patients. Int Orthop 37:1135–1140PubMedCrossRefGoogle Scholar
  10. 10.
    No Authors Listed. The National Hip Fracture Database National Report (2011). Available online at http://www.nhfd.co.uk/003/hipfractureR.nsf/NHFDNationalReport2011_Final.pdf. Last accessed 20 December 2012.
  11. 11.
    Khan MA, Hossain FS, Dashti Z, Muthukumar N (2012) Causes and predictors of early re-admission after surgery for a fracture of the hip. J Bone Joint Surg Br 94:690–697PubMedGoogle Scholar
  12. 12.
    World Health Organization. International Classification of Diseases (ICD): 10th revision (2010). Available online at http://www.who.int/classifications/icd10/ Last accessed 20 December 2012.
  13. 13.
    British Orthopaedic Association Standards for Trauma (BOAST 1) Guideline (2008). Available online at http://www.boa.ac.uk/LIB/LIBPUB/Documents/BOAST 1 - Hip Fracture in the Older Person Version 1–2008.pdf (last accessed 20 December 2012).
  14. 14.
    Nielsen KA, Jensen NC, Jensen CM, Thomsen M, Pedersen L, Johnsen SP, Ingeman A, Bartels PD, Thomsen RW (2009) Quality of care and 30 day mortality among patients with hip fractures: a nationwide cohort study. BMC Health Serv Res 9:186PubMedCrossRefGoogle Scholar
  15. 15.
    Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302:1573–1579PubMedCrossRefGoogle Scholar
  16. 16.
    Perez JV, Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femoral fracture–an autopsy study. Injury 26:237–240PubMedCrossRefGoogle Scholar
  17. 17.
    Aoki A, Sato T, Igarashi T (2003) Effect of pneumonia on clinical course and prognosis after hip fracture. Nihon Ronen Igakkai Zasshi 40:615–619PubMedCrossRefGoogle Scholar
  18. 18.
    French DD, Bass E, Bradham DD, Campbell RR, Rubenstein LZ (2008) Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc 56:705–710PubMedCrossRefGoogle Scholar
  19. 19.
    Muraki S, Yamamoto S, Ishibashi H, Nakamura K (2006) Factors associated with mortality following hip fracture in Japan. J Bone Miner Metab 24:100–104PubMedCrossRefGoogle Scholar
  20. 20.
    Sennerby U, Farahmand B, Ahlbom A, Ljunghall S, Michaelsson K (2007) Cardiovascular diseases and future risk of hip fracture in women. Osteoporos Int 18:1355–1362PubMedCrossRefGoogle Scholar
  21. 21.
    Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673PubMedCrossRefGoogle Scholar
  22. 22.
    Bass E, French DD, Bradham DD, Rubenstein LZ (2007) Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol 17:514–519PubMedCrossRefGoogle Scholar
  23. 23.
    Gupta BP, Huddleston JM, Kirkland LL, Huddleston PM, Larson DR, Gullerud RE, Burton MC, Rihal CS, Wright RS (2012) Clinical presentation and outcome of perioperative myocardial infarction in the very elderly following hip fracture surgery. J Hosp Med 7:713–6PubMedCrossRefGoogle Scholar
  24. 24.
    Dawson-Bowling S, Chettiar K, Cottam H, Worth R, Forder J, Fitzgerald-O’Connor I, Walker D, Apthorp H (2008) Troponin T as a predictive marker of morbidity in patients with fractured neck of femur. Injury 39:775–780PubMedCrossRefGoogle Scholar
  25. 25.
    Sandhu A, Sanders S, Geraci SA (2012) Prognostic value of cardiac troponins in elderly patients with hip fracture-a systematic review. Osteoporos Int 24:1145–9PubMedCrossRefGoogle Scholar
  26. 26.
    Talsnes O, Hjelmstedt F, Dahl OE, Pripp AH, Reikeras O (2011) Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly. Int Orthop 35:903–907PubMedCrossRefGoogle Scholar
  27. 27.
    Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182:1609–1616PubMedCrossRefGoogle Scholar
  28. 28.
    Carretta E, Bochicchio V, Rucci P, Fabbri G, Laus M, Fantini MP (2011) Hip fracture: effectiveness of early surgery to prevent 30-day mortality. Int Orthop 35:419–424PubMedCrossRefGoogle Scholar
  29. 29.
    Vochteloo AJ, Tuinebreijer WE, Maier AB, Nelissen RG, Bloem RM, Pilot P (2012) Predicting discharge location of hip fracture patients; the new discharge of hip fracture patients score. Int Orthop 36:1709–1714PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Muhammad Asim Khan
    • 1
    • 2
    Email author
  • Fahad Siddique Hossain
    • 1
  • Iftikhar Ahmed
    • 1
  • Nagarajan Muthukumar
    • 1
  • Amr Mohsen
    • 1
  1. 1.Department of Trauma & OrthopaedicsHull Royal InfirmaryHullUK
  2. 2.LondonUK

Personalised recommendations