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Excess mortality after pelvic fractures in institutionalized older people

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Abstract

Summary

Mortality after pelvic fracture was calculated in residents of nursing homes. Compared with a matched comparison nonfracture group, excess mortality was found during the first 2 months after pelvic fracture.

Introduction

Low energy pelvic fractures are mainly observed in people of advanced older age. The incidence of these fractures has increased considerably during the last decades. Information about excess mortality after pelvic fractures in older people is not available.

Methods

To calculate excess mortality, a retrospective cohort study was conducted. Data from residents institutionalized in Bavarian nursing homes between 2001 and 2006 were used. For each patient with a pelvic fracture (n = 1,154), five residents without pelvic fracture (n = 5,770) were matched by sex, age, date of admission to the nursing home, and level of care (measure for the need of care). Hazard regression models were applied.

Results

An excess mortality was found during the first months after pelvic fracture. In women, the increased mortality risk was limited to the first (hazard rate ratio (HR) 1.83, 95% confidence interval (CI) 1.42–2.37) and second (HR 1.52, 95% CI 1.13–2.04) months after the injury. In men, excess mortality was more pronounced (HR 2.95, 95% CI 1.57–5.54 for the first month) and appeared to last longer than in women. The majority of deaths due to pelvic fractures in the first 2 months after injury occurred following discharge from the hospital to the nursing home.

Conclusion

Pelvic fractures are associated with an increased mortality. These results should encourage the development of preventive measures to reduce this excess mortality.

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References

  1. Ragnarsson B, Jacobsson B (1992) Epidemiology of pelvic fractures in a Swedish county. Acta Orthop Scand 63(3):297–300

    Article  CAS  PubMed  Google Scholar 

  2. Balogh Z, King KL, Mackay P, McDougall D, Mackenzie S, Evans JA, Lyons T, Deane SA (2007) The epidemiology of pelvic ring fractures: a population-based study. J Trauma 63(5):1066–1073

    Article  PubMed  Google Scholar 

  3. Parkkari J, Kannus P, Niemi S, Pasanen M, Jarvinen M, Luthje P, Vuori I (1996) Secular trends in osteoporotic pelvic fractures in Finland: number and incidence of fractures in 1970–1991 and prediction for the future. Calcif Tissue Int 59(2):79–83

    Article  CAS  PubMed  Google Scholar 

  4. Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M (2000) Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970–1997 and alarming projections for the new millennium. Osteoporos Int 11(5):443–448

    Article  CAS  PubMed  Google Scholar 

  5. Kannus P, Palvanen M, Parkkari J, Niemi S, Jarvinen M (2005) Osteoporotic pelvic fractures in elderly women. Osteoporos Int 16(10):1304–1305

    Article  PubMed  Google Scholar 

  6. Boufous S, Finch C, Lord S, Close J (2005) The increasing burden of pelvic fractures in older people, New South Wales, Australia. Injury 36(11):1323–1329

    Article  PubMed  Google Scholar 

  7. Spencer JD, Lalanadham T (1985) The mortality of patients with minor fractures of the pelvis. Injury 16(5):321–323

    Article  CAS  PubMed  Google Scholar 

  8. Morris RO, Sonibare A, Green DJ, Masud T (2000) Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards. Postgrad Med J 76(900):646–650

    Article  CAS  PubMed  Google Scholar 

  9. Leung WY, Ban CM, Lam JJ, Ip FK, Ko PS (2001) Prognosis of acute pelvic fractures in elderly patients: retrospective study. Hong Kong Med J 7(2):139–145

    CAS  PubMed  Google Scholar 

  10. Becker C, Leistner K, Nikolaus T (1998) Introducing a statutory insurance system for long-term care (Pflegeversicherung) in Germany. In: Michel JP, Rubenstein LZ, Vellas BJ, Albarede JL (eds) Geriatric programs and departments around the world. Serd-Springer, Paris-New York, pp 55–64

    Google Scholar 

  11. Bundesministerium für Gesundheit long-term care insurance. Homepage (serial online) Available at: http://www.bmg.bund.de/cln_040/nn_617014/EN/Long-term-care-insurance/long-term-care-insurance-node,param=.html__nnn=true

  12. Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1992) Race and sex differences in mortality following fracture of the hip. Am J Public Health 82(8):1147–1150

    Article  CAS  PubMed  Google Scholar 

  13. Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137(9):1001–1005

    CAS  PubMed  Google Scholar 

  14. Schroder HM, Erlandsen M (1993) Age and sex as determinants of mortality after hip fracture: 3,895 patients followed for 2.5–18.5 years. J Orthop Trauma 7(6):525–531

    Article  CAS  PubMed  Google Scholar 

  15. Forsen L, Sogaard AJ, Meyer HE, Edna T, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10(1):73–78

    Article  CAS  PubMed  Google Scholar 

  16. Hannan EL, Magaziner J, Wang JJ, Eastwood EA, Silberzweig SB, Gilbert M, Morrison RS, McLaughlin MA, Orosz GM, Siu AL (2001) Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 285(21):2736–2742

    Article  CAS  PubMed  Google Scholar 

  17. Rapp K, Becker C, Lamb SE, Icks A, Klenk J (2008) Hip fractures in institutionalized elderly people: incidence rates and excess mortality. J Bone Miner Res 23(11):1825–1831

    Article  PubMed  Google Scholar 

  18. Fransen M, Woodward M, Norton R, Robinson E, Butler M, Campbell AJ (2002) Excess mortality or institutionalization after hip fracture: men are at greater risk than women. J Am Geriatr Soc 50(4):685–690

    Article  PubMed  Google Scholar 

  19. Holt G, Smith R, Duncan K, Hutchison JD, Gregori A (2008) Gender differences in epidemiology and outcome after hip fracture: evidence from the Scottish Hip Fracture Audit. J Bone Jt Surg Br 90(4):480–483

    Article  CAS  Google Scholar 

  20. Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J (2003) Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res 18(12):2231–2237

    Article  PubMed  Google Scholar 

  21. Piirtola M, Vahlberg T, Lopponen M, Raiha I, Isoaho R, Kivela SL (2008) Fractures as predictors of excess mortality in the aged-a population-based study with a 12-year follow-up. Eur J Epidemiol 23(11):747–755

    Article  PubMed  Google Scholar 

  22. Cameron ID, Chen JS, March LM, Simpson JM, Cumming RG, Seibel MJ, Sambrook PN (2009) Hip fracture causes excess mortality due to cardiovascular and infectious disease in institutionalized older people: a prospective five-year study. J Bone Miner Res. Oct 19. [Epub ahead of print]

  23. Browner WS, Pressman AR, Nevitt MC, Cummings SR (1996) Mortality following fractures in older women. The study of osteoporotic fractures. Arch Intern Med 156(14):1521–1525

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Regina Merk-Bäuml, Ralf Brum, Johannes Laws-Hofmann, Gerhard Dahlhoff, Otto Gieseke, Michaela Heil, Stefanie Dörfler, and Markus Gindl from the Allgemeine Ortskrankenkasse (AOK) and Ulrich Rissmann from the Robert-Bosch Hospital, Stuttgart for the admission to the data and for the support of our analyses.

Conflicts of interest

None.

Funding

The analysis was supported by a grant of the Forschungskolleg Geriatrie of the Robert Bosch Foundation and by the Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01EL0702, 01EL0717, 01EL0718).

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Authors and Affiliations

  1. Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany

    K. Rapp, J. Klenk & C. Becker

  2. Institute of Epidemiology, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany

    K. Rapp, J. Klenk & A. Kleiner

  3. Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Ryde, NSW, Australia

    I. D. Cameron

  4. Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia

    S. Kurrle

  5. Department of Psychiatry, Health Economics Research Unit, University of Leipzig, Liebigstraße 26, 04103, Leipzig, Germany

    S. Heinrich & H.-H. König

Authors
  1. K. Rapp
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  2. I. D. Cameron
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  3. S. Kurrle
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  4. J. Klenk
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  5. A. Kleiner
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  6. S. Heinrich
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  7. H.-H. König
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  8. C. Becker
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Correspondence to K. Rapp.

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Rapp, K., Cameron, I.D., Kurrle, S. et al. Excess mortality after pelvic fractures in institutionalized older people. Osteoporos Int 21, 1835–1839 (2010). https://doi.org/10.1007/s00198-009-1154-0

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  • DOI: https://doi.org/10.1007/s00198-009-1154-0

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