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Risk factors of mortality and second fracture after elderly hip fracture surgery in Shanghai, China

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Abstract

Introduction

Hip fracture is one of the leading causes of death and disability in the elderly. We analyzed the risk factors of mortality and second fracture within 2 years after hip fracture surgery in elderly Chinese patients.

Materials and methods

A total of 613 elderly patients after hip fracture surgery were selected, including 181 males and 432 females, and the patients were followed for at least 24 months. Information about patients and surgery was collected from medical records. Information on death, secondary fracture, and postoperative activities of daily living (ADL) was obtained by telephone follow-up. Cox regression was performed to identify risk factors associated with mortality and second fracture, measured by hazard ratio (HR).

Results

The 1-year and 2-year mortality rates after hip fracture were 13.4% and 20.7%, respectively. The second fracture rate within 2 years was 9.5%. Male gender (HR 1.51, P = 0.035), increased age (HR 1.07, P < 0.001), preoperative hypoalbuminemia (HR 1.79, P = 0.004), preoperative pneumonia (HR 2.60, P = 0.005) and poor ADL (P = 0.048) were independent risk factors for 2-year mortality, while high preoperative hemoglobin (HR 0.98, P = 0.002), high preoperative eGFR (HR 0.99, P = 0.031), high preoperative LVEF (HR 0.92, P = 0.048) were protective factors for 2-year mortality. Poor ADL (P = 0.002) was the independent risk factor for second fracture within 2 years.

Conclusions

The 2-year mortality rate and second fracture rate after hip fracture in elderly remained high, which was related to old age and complications exists. Postoperative rehabilitation and improving ADL were very important to reduce mortality and second fracture.

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References

  1. Zhang C, Feng J, Wang S et al (2020) Incidence of and trends in hip fracture among adults in urban China: a nationwide retrospective cohort study. Plos Med 17:e1003180

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ballane G, Cauley JA, Luckey MM, Fuleihan G (2014) Secular trends in hip fractures worldwide: opposing trends East versus West. J Bone Miner Res 29:1745–1755

    Article  PubMed  Google Scholar 

  3. de Luise C, Brimacombe M, Pedersen L, Sørensen HT (2013) Comorbidity and mortality following hip fracture: a population-based cohort study. Aging Clin Exp Res 20:412–418

    Article  Google Scholar 

  4. Solbakken SM, Meyer HE, Stigum H et al (2017) Excess mortality following hip fracture: impact of self-perceived health, smoking, and body mass index. A NOREPOS study. Osteoporosis Int 28:881–887

    Article  CAS  Google Scholar 

  5. Katsoulis M, Benetou V, Karapetyan T et al (2017) Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med 281:300–310

    Article  CAS  PubMed  Google Scholar 

  6. Omsland TK, Emaus N, Tell GS et al (2013) Ten-year risk of second hip fracture. A NOREPOS study. Bone 52:493–497

    Article  PubMed  Google Scholar 

  7. Colon-Emeric C, Kuchibhatla M, Pieper C et al (2003) The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 14:879–883

    Article  PubMed  Google Scholar 

  8. Pabich S, Binkley N (2020) Trends in hip fracture mortality in Wisconsin and the United States, 1999–2017. WMJ 119:48–51

    PubMed  Google Scholar 

  9. Shanghai Bureau of Statistics. Shanghai statistical. Yearbook. 2021

  10. Kim SM, Moon YW, Lim SJ et al (2012) Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 50:1343–1350

    Article  PubMed  Google Scholar 

  11. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  PubMed  PubMed Central  Google Scholar 

  12. Johansen A, Mansor M, Beck S, Mahoney H, Thomas S (2010) Outcome following hip fracture: post-discharge residence and long-term mortality. Age Ageing 39:653–656

    Article  PubMed  Google Scholar 

  13. Xing F, Luo R, Chen W, Zhou X (2021) The risk-adjusted Charlson comorbidity index as a new predictor of one-year mortality rate in elderly Chinese patients who underwent hip fracture surgery. Orthop Traumatol Surg Res 107:102860

    Article  PubMed  Google Scholar 

  14. Ireland AW, Kelly PJ, Cumming RG (2015) Risk factor profiles for early and delayed mortality after hip fracture: analyses of linked Australian Department of Veterans’ Affairs databases. Injury 46:1028–1035

    Article  PubMed  Google Scholar 

  15. Hori K, Siu AM, Nguyen ET et al (2020) Osteoporotic hip fracture mortality and associated factors in Hawai’i. Arch Osteoporos 15:183

    Article  PubMed  Google Scholar 

  16. 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 Joint J 97-B:246–251

    Article  CAS  PubMed  Google Scholar 

  17. 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 351:h6246

    Article  PubMed  PubMed Central  Google Scholar 

  18. Penrod JD, Litke A, Hawkes WG et al (2008) The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 63:867–872

    Article  PubMed  Google Scholar 

  19. 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 19:29–35

    Article  PubMed  Google Scholar 

  20. Tebe C, Martinez-Laguna D, Carbonell-Abella C et al (2019) The association between type 2 diabetes mellitus, hip fracture, and post-hip fracture mortality: a multi-state cohort analysis. Osteoporos Int 30:2407–2415

    Article  CAS  PubMed  Google Scholar 

  21. Anbar R, Beloosesky Y, Cohen J et al (2014) Tight calorie control in geriatric patients following hip fracture decreases complications: a randomized, controlled study. Clin Nutr 33:23–28

    Article  CAS  PubMed  Google Scholar 

  22. Koren-Hakim T, Weiss A, Hershkovitz A et al (2012) The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome. Clin Nutr 31:917–921

    Article  PubMed  Google Scholar 

  23. Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marin-Ciancas F, Malafarina V (2015) Serum albumin and health in older people: review and meta analysis. Maturitas 81:17–27

    Article  CAS  PubMed  Google Scholar 

  24. Bohl DD, Shen MR, Hannon CP, Fillingham YA, Darrith B, Della VC (2017) Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. J Bone Joint Surg Am 99:2110–2118

    Article  PubMed  Google Scholar 

  25. Miyanishi K, Jingushi S, Torisu T (2010) Mortality after hip fracture in Japan: the role of nutritional status. J Orthop Surg (Hong Kong) 18:265–270

    Article  PubMed  Google Scholar 

  26. Schuijt HJ, Smeeing D, Wurdemann FS et al (2020) Development and internal validation of a prediction model for in-hospital mortality in geriatric patients with a hip fracture. J Orthop Trauma 34:656–661

    Article  PubMed  Google Scholar 

  27. Praetorius K, Madsen CM, Abrahamsen B, Jorgensen HL, Lauritzen JB, Laulund AS (2016) Low levels of hemoglobin at admission are associated with increased 30-day mortality in patients with hip fracture. Geriatr Orthop Surg Rehabil 7:115–120

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sim YE, Sim SD, Seng C, Howe TS, Koh SB, Abdullah HR (2018) Preoperative anemia, functional outcomes, and quality of life after hip fracture surgery. J Am Geriatr Soc 66:1524–1531

    Article  PubMed  Google Scholar 

  29. Williams D, Ohnuma T, Haines KL et al (2021) Association between early postoperative nutritional supplement utilisation and length of stay in malnourished hip fracture patients. Br J Anaesth 126:730–737

    Article  PubMed  Google Scholar 

  30. Malafarina V, Reginster JY, Cabrerizo S et al (2018) Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients 10:555

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cher EWL, Allen JC, Moo IH et al (2020) Sub-optimal serum 25-hydroxyvitamin D level affects 2-year survival after hip fracture surgery. J Bone Miner Metab 38:555–562

    Article  CAS  PubMed  Google Scholar 

  32. Hao L, Carson JL, Schlussel Y, Noveck H, Shapses SA (2020) Vitamin D deficiency is associated with reduced mobility after hip fracture surgery: a prospective study. Am J Clin Nutr 112:613–618

    Article  PubMed  PubMed Central  Google Scholar 

  33. Castle M, Fiedler N, Pop LC et al (2020) Three doses of vitamin d and cognitive outcomes in older women: a double-blind randomized controlled trial. J Gerontol A Biol Sci Med Sci 75:835–842

    Article  CAS  PubMed  Google Scholar 

  34. Stockton KA, Mengersen K, Paratz JD, Kandiah D, Bennell KL (2011) Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporos Int 22:859–871

    CAS  PubMed  Google Scholar 

  35. Mazzucchelli ER, Perez-Fernandez E, Crespi-Villarias N et al (2017) Trends in osteoporotic hip fracture epidemiology over a 17-year period in a Spanish population: alcorcon 1999–2015. Arch Osteoporos 12:84

    Article  Google Scholar 

  36. Chen M, Zhang Y, Du Y et al (2019) Epidemiological and clinical study of hip fracture in hospitalized elderly patients in Shanghai. China Arch Osteoporos 14:37

    Article  PubMed  Google Scholar 

  37. Guzon-Illescas O, Perez FE, Crespi VN et al (2019) Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res 14:203

    Article  PubMed  PubMed Central  Google Scholar 

  38. Foss NB, Kehlet H (2005) Mortality analysis in hip fracture patients: implications for design of future outcome trials. Br J Anaesth 94:24–29

    Article  CAS  PubMed  Google Scholar 

  39. Bai J, Zhang P, Liang X, Wu Z, Wang J, Liang Y (2018) Association between dementia and mortality in the elderly patients undergoing hip fracture surgery: a meta-analysis. J Orthop Surg Res 13:298

    Article  PubMed  PubMed Central  Google Scholar 

  40. Jurisson M, Raag M, Kallikorm R, Lember M, Uuskula A (2017) The impact of comorbidities on hip fracture mortality: a retrospective population-based cohort study. Arch Osteoporos 12:76

    Article  PubMed  Google Scholar 

  41. Caruso G, Andreotti M, Marko T et al (2019) The impact of warfarin on operative delay and 1-year mortality in elderly patients with hip fracture: a retrospective observational study. J Orthop Surg Res 14:169

    Article  PubMed  PubMed Central  Google Scholar 

  42. de Palma L, Torcianti M, Meco L, Catalani A, Marinelli M (2014) Operative delay and mortality in elderly patients with hip fracture: an observational study. Eur J Orthop Surg Traumatol 24:783–788

    Article  PubMed  Google Scholar 

  43. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD (1997) Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 11:162–165

    Article  CAS  PubMed  Google Scholar 

  44. Heinonen M, Karppi P, Huusko T, Kautiainen H, Sulkava R (2004) Post-operative degree of mobilization at two weeks predicts one-year mortality after hip fracture. Aging Clin Exp Res 16:476–480

    Article  PubMed  Google Scholar 

  45. Sujic R, Beaton DE, Mamdani M et al (2019) Five-year refracture rates of a province-wide fracture liaison service. Osteoporos Int 30:1671–1677

    Article  CAS  PubMed  Google Scholar 

  46. Pogliacomi F, Pellegrini A, Tacci F et al (2016) Risks of subsequent contralateral fractures of the trochanteric region in elderly. Acta Biomed 87:275–281

    PubMed  Google Scholar 

  47. Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P (2009) Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977–2001. J Bone Miner Res 24:1299–1307

    Article  PubMed  Google Scholar 

  48. Yamanashi A, Yamazaki K, Kanamori M et al (2005) Assessment of risk factors for second hip fractures in Japanese elderly. Osteoporos Int 16:1239–1246

    Article  PubMed  Google Scholar 

  49. Kozaki K (2013) Fall risk and fracture. Aging and fall/fracture. Clin Calcium 23:653–660

    PubMed  Google Scholar 

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Acknowledgements

We thank all participants in the study. We also thank the Department of Orthopedics, Huadong Hospital affiliated to Fudan University, for providing patient records.

Funding

This study was supported by the China National Key R&D Program (Nos. 2020YFC2009000 and 2020YFC2009001), the Shanghai Public Health System Construction Three-year Action Plan Project (GWV-9.4), and Shanghai Key Laboratory of Clinical Geriatric Medicine (13dz2260700).

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Authors and Affiliations

  1. Research Section of Geriatric Metabolic Bone Disease, Department of Osteoporosis and Bone Disease, Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, 221 West Yan An Road, Shanghai, 200040, China

    Minmin Chen, Yanping Du, Wenjing Tang, Weijia Yu, Huilin Li & Qun Cheng

  2. Shanghai Geriatric Institute, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China

    Minmin Chen, Yanping Du, Wenjing Tang, Weijia Yu, Huilin Li, Songbai Zheng & Qun Cheng

Authors
  1. Minmin Chen
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  2. Yanping Du
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  4. Weijia Yu
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  5. Huilin Li
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  6. Songbai Zheng
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  7. Qun Cheng
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Contributions

MMC: contributed to the study design, performed data collect, data analysis, drafted the main manuscript, and provided final approval for submission; YPD, WJT, WJY and HLL: contributed to performed data collect, and provided final approval for submission; SBZ: contributed to the study design, and provided final approval for submission; QC: contributed to the study design, reviewed the manuscript critically for important intellectual content, and provided final approval.

Corresponding author

Correspondence to Qun Cheng.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Huadong Hospital, Fudan University (Ethics Number: 2019K168) in compliance with the Declaration of Helsinki, in which the patient data used were kept strictly confidential.

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Chen, M., Du, Y., Tang, W. et al. Risk factors of mortality and second fracture after elderly hip fracture surgery in Shanghai, China. J Bone Miner Metab 40, 951–959 (2022). https://doi.org/10.1007/s00774-022-01358-y

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  • DOI: https://doi.org/10.1007/s00774-022-01358-y

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