Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 5, pp 597–604 | Cite as

Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank

  • Philip J. BelmontJr.
  • E’Stephan J. Garcia
  • David Romano
  • Julia O. Bader
  • Kenneth J. Nelson
  • Andrew J. Schoenfeld
Orthopaedic Surgery

Abstract

Study design

Retrospective review of prospectively collected data.

Objective

To describe the impact of patient demographics, injury-specific factors, and medical co-morbidities on outcomes after hip fracture using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB).

Methods

The 2008 NSP-NTDB was queried to identify patients sustaining hip fractures. Patient demographics, co-morbidities, injury-specific factors, and outcomes (including mortality and complications) were recorded and a national estimate model was developed. Unadjusted differences for risk factors were evaluated using t test/Wald Chi square analyses. Weighted logistic regression and sensitivity analyses were performed to control for all factors in the model.

Results

The weighted sample contained 44,419 incidents of hip fracture. The average age was 72.7. Sixty-two percent of the population was female and 80 % was white. The mortality rate was 4.5 % and 12.5 % sustained at least one complication. Seventeen percent of patients who sustained at least one complication died. Dialysis, presenting in shock, cardiac disease, male sex, and ISS were significant predictors of mortality, while dialysis, obesity, cardiac disease, diabetes, and a procedure delay of ≥2 days influenced complications. The major potential modifiable risk factor appears to be time to procedure, which had a significant impact on complications.

Conclusions

This is the first study to postulate predictors of morbidity and mortality following hip fracture in a US national model. While many co-morbidities appear to be influential in predicting outcome, some of the more significant factors include the presence of shock, dialysis, obesity, and time to surgery.

Level of evidence

Prognostic study, Level II.

Keywords

Hip fracture Mortality Complications 

Notes

Conflict of interest

None.

References

  1. 1.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRefGoogle Scholar
  2. 2.
    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767PubMedCrossRefGoogle Scholar
  3. 3.
    Haleem S, Lutchman l, Mayahi R, Grice JE, Parker MJ (2008) Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 39:1157–1163PubMedCrossRefGoogle Scholar
  4. 4.
    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
  5. 5.
    Hip fractures among older adults. Atlanta: Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. http://www.cdc.gov/ncipc/factsheets/adulthip-fx.htm. Accessed 17 June 2012
  6. 6.
    Hochberg MC, Williamson J, Skinner EA et al (1998) The prevalence and impact of self-reported hip fracture in elderly community-dwelling women: the Women’s Health and Aging Study. Osteoporos Int 8:385–389PubMedCrossRefGoogle Scholar
  7. 7.
    Leslie WD, O’Donnell S, Jean S et al (2009) Trends in hip fractures in Canada. JAMA 302:883–889PubMedCrossRefGoogle Scholar
  8. 8.
    Parker MJ, Handoll HH, Griffiths R (2004) Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 4:CD000521PubMedGoogle Scholar
  9. 9.
    Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152(6):380–390PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Moran CG, Wenn RT, Sikand M et al (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489PubMedCrossRefGoogle Scholar
  11. 11.
    Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ (2003) Mortality risk after hip fracture. 2003. J Orthop Trauma 17(8 Suppl):S2–S5PubMedCrossRefGoogle Scholar
  12. 12.
    Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Rosell PA, Parker MJ (2003) Functional outcome after hip fracture. A 1-year prospective outcome study of 275 patients. Injury 34:529–532PubMedCrossRefGoogle Scholar
  14. 14.
    Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD (1998) Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res 348:22–28PubMedGoogle Scholar
  15. 15.
    Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD (1995) Ambulatory ability after hip fracture in the elderly. A prospective study in geriatric patients. Clin Orthop Relat Res 310:150–159PubMedGoogle Scholar
  16. 16.
    Pretto M, Spirig R, Kaelin R, Muri-John V, Kressig RW, Suhm N (2010) Outcomes of elderly hip fracture patients in the Swiss healthcare system. Swiss Med Wkly 140:w13086PubMedGoogle Scholar
  17. 17.
    Bosch U, Schreiber T, Krettek C (2002) Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res 399:59–71PubMedCrossRefGoogle Scholar
  18. 18.
    Zuckerman JD (1996) Hip fracture. N Engl J Med 334:1519–1525PubMedCrossRefGoogle Scholar
  19. 19.
    Elder GM, Harvey EJ, Vaidya R, Guy P, Meek RN, Aebi M (2005) The effectiveness of orthopaedic trauma theatres in decreasing morbidity and mortality: a study of 701 displaced subcapital hip fractures in two trauma centres. Injury 36:1060–1066PubMedCrossRefGoogle Scholar
  20. 20.
    Butler P, Forte ML, Joglekar SB, Swiontkowski MF, Kane RL (2011) Evidence summary: systematic review of surgical treatments for geriatric hip fractures. J Bone Joint Surg Am 93:1104–1115PubMedCrossRefGoogle Scholar
  21. 21.
    Sullivent EE, Faul M, Wald MM (2011) Reduced mortality in injured adults transported by helicopter emergency medical services. Prehosp Emerg Care 15:295–302PubMedCrossRefGoogle Scholar
  22. 22.
    Bukur M, Castelo Branco B, Inaba K, Cestero R, Kobayashi L, Tang A, Demetriades D (2012) The impact of American College of Surgeons trauma center designation and outcomes after early thoracotomy: a National Trauma Databank analysis. Am Surg 78:36–41PubMedGoogle Scholar
  23. 23.
    Branco BC, Inaba K, Bukur M, Talving P, Oliver M, David JS, Lam L, Demetriades D (2011) Risk factors for delirium in trauma patients: the impact of ethanol use and lack of insurance. Am Surg 77:621–626PubMedGoogle Scholar
  24. 24.
    Sperry JL, Vodovotz Y, Ferrell RE, Namas R, Chai YM, Feng QM, Jia WP, Forsythe RM, Peitzman AB, Billiar TR (2012) Racial disparities and sex-based outcomes differences after severe injury. J Am Coll Surg 214:973–980PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Haider AH, Saleem T, Leow JJ, Villegas CV, Kisat M, Schneider EB, Haut ER, Stevens KA, Cornwell EE 3rd, MacKenzie EJ, Efron DT (2012) Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact? J Am Coll Surg 214:756–768PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    American College of Surgeons. National Trauma Data Bank (NTDB) National sample Program, Arrival Year 2008 (February, 2010). Instructional Manual. Available at: http://www.facs.org/trauma/ntdb/nsp.html. Accessed 3 June 2012
  27. 27.
    Endo Y, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ (2005) Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma 19:29–35PubMedCrossRefGoogle Scholar
  28. 28.
    Smektala R, Endres H, Dasch B et al (2008) The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord 9:171PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Hu F, Jiang C, Shen J, Tang P, Wang Y (2011) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43(6):676–685PubMedGoogle Scholar
  30. 30.
    Alzahrani K, Gandhi R, Davis A, Mahomed N (2010) In-hospital mortality following hip fracture care in southern Ontario. Can J Surg 53:294–298PubMedCentralPubMedGoogle Scholar
  31. 31.
    Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV (2011) Risk factors for in-hospital post-hip fracture mortality. Bone 49:553–558PubMedCrossRefGoogle Scholar
  32. 32.
    Johansen A, Mansor M, Mahoney H, Thomas S (2010) Outcome following hip fracture: post-discharge residence and long term mortality. Age Ageing 39:653–656PubMedCrossRefGoogle Scholar
  33. 33.
    Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: an observational study. BMJ 332:947–951PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Kang H, Yang K, Kim YN, Moon S, Choi W, Kang DR, Park SE (2010) Incidence and mortality of hip fracture among elderly population in South Korea: a population-based study using the National Health Insurance claims data. BMC Public Health 10:230–239PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Kannegaard PN, Van Der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209PubMedCrossRefGoogle Scholar
  36. 36.
    Holt G, Smith R, Duncan K, McKeown DW (2010) Does delay to theatre for medical reasons affect the peri-operative mortality in patients with a fracture of the hip? J Bone Joint Surg Br 92-B:835–841CrossRefGoogle Scholar
  37. 37.
    Simunovic N, Devereaux MD, 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(15):1609–1616PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    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 35:419–424PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    McGuire KJ, Bernstein J, Polsky D, Silber JH (2004) The 2004 Marshal Urist award: delays until surgery after hip fracture increase mortality. Clin Orthop Relat Res 428:294–301PubMedCrossRefGoogle Scholar
  40. 40.
    Holt G, Smith R, Duncan K, Finlayson DF, Gregori A (2008) Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from Scotish hip fracture audit. J Bone Joint Surg Br 90(10):1357–1363PubMedCrossRefGoogle Scholar
  41. 41.
    Sund R, Liski A (2005) Quality effects of operative delay on mortality in hip fracture treatment. Qual Saf Health Care 14(5):371–377PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Rodriguez-Fernandez P, Adarraga-Cansino, Carpintero P (2011) Effects of delayed hip fracture surgery on mortality and morbidity in elderly patients. Clin Orthop Relat Res 469:3218–3221PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ (2009) Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury 40(7):692–697PubMedCrossRefGoogle Scholar
  44. 44.
    Shiga T, Wajima A, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 55(3):146–154PubMedCrossRefGoogle Scholar
  45. 45.
    Cameron ID, Chen JS, March LM, Simpson JM, Cumming RG, Seibel MJ, Sambrook PN (2010) Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: a prospective 5-year study. J Bone Miner Res 25(4):866–872PubMedGoogle Scholar
  46. 46.
    Edwards C, Counsell A, Boulton C, Moran CG (2012) Early infection after hip fracture surgery: risk factors, costs and outcome. J Bone Joint Surg Br 90-B:770–777CrossRefGoogle Scholar
  47. 47.
    Garcia-Alvarez F, Al-Ghanem R, Garcia-Alvarez I, Lopez-Baisson A, Bernal M (2010) Risk factors for postoperative infections in patients with hip fracture treated by means of Thompson arthroplasty. Arch Gerontol Geriatr 50:51–55PubMedCrossRefGoogle Scholar
  48. 48.
    Harrison T, Robinson P, Cook A, Parker MJ (2012) Factors affecting the incidence of deep wound infection after hip fracture surgery. J Bone Joint Surg Br 94:237–240PubMedCrossRefGoogle Scholar
  49. 49.
    Merrer J, Girou E, Lortat-Jacob A, Montravers P, Lucet J (2007) Surgical site infection after surgery to repair femoral neck fracture: a French multicenter retrospective study. Infect Control Hosp Epidemiol 28(10):1169–1174PubMedCrossRefGoogle Scholar
  50. 50.
    Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91(7):922–927PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg (outside the USA) 2014

Authors and Affiliations

  • Philip J. BelmontJr.
    • 1
  • E’Stephan J. Garcia
    • 1
  • David Romano
    • 1
  • Julia O. Bader
    • 2
  • Kenneth J. Nelson
    • 1
  • Andrew J. Schoenfeld
    • 3
  1. 1.Department of Orthopaedic Surgery, William Beaumont Army Medical CenterTexas Tech University Health Sciences CenterEl PasoUSA
  2. 2.Statistical Consulting LaboratoryUniversity of Texas at El PasoEl PasoUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of MichiganAnn ArborUSA

Personalised recommendations