Study outlines risk factors for poor outcome, mortality following hip fracture

March 21, 2013

A new study, presented today at the 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), identifies predictors of complications and mortality following a hip fracture, including dialysis, cardiac disease, diabetes, and a longer time before surgery – the only modifiable risk factor when patients are hospitalized.

Each year, more than 340,000 Americans are hospitalized for hip fractures. According to AAOS data, 69 percent of are female and 46 percent are between the ages of 65 and 84. Many hip fracture patients suffer with life-altering consequences. The estimated rate within one year of a hip fracture ranges from 12 to 33 percent.

In the study, researchers used data from the 2008 National Sample Program (NSP) of the National Trauma Data Bank (NTBD) to identify a of 44,419 hip fractures. Among the specifics:

  • The average patient age was age 72.7.
  • Sixty-two percent of patients were female.
  • Patient demographics, medical comorbidities, injury-specific factors and outcomes were recorded and a national estimate model developed for analysis.
Primary outcomes included mortality and the development of complications (4.5 percent and 12.5 percent, respectively). Seventeen percent of patients who sustained at least one complication died. Secondary measures consisted of the development of specific complications such as pulmonary/cardiac complications, venous thromboembolic disease and infection.

Hypertension and diabetes were the most common medical comorbidities among patients. Dialysis, presenting in shock, , male sex and a high Injury Severity Score (ISS) were significant predictors of mortality. Dialysis, shock, obesity, cardiac disease, diabetes and a greater time to surgery significantly influenced the risk of developing one or more post-operative complications. Obesity, femoral neck (the uppermost section of the ) fracture, cardiac disease and diabetes significantly increased the risk of developing major complications. The presence of shock following injury was the most important predictor of both cardiac and venous thromboembolic disease complications with an odds ratio exceeding 10 for the development of .

"Most of the predictors of complications and mortality are non-modifiable," including the presence of significant cardiac/respiratory disease, diabetes, dependence on dialysis and presentation to the hospital in shock, said Philip J. Belmont, Jr., MD, an orthopaedic surgeon at the William Beaumont Army Medical Center in El Paso, Texas, and the lead author of the study.

"Reduced time to surgical intervention appears to be the single greatest factor with which a surgeon might influence the risk of mortality or complications," said Dr. Belmont. A previous study has shown a 41 percent increase in mortality if surgery is delayed 48 hours or more. The majority of patients are taken into surgery within 24 hours.

In older hip fracture patients, the pre-operative "work-up," and/or the correction of major clinical abnormalities – important and frequent considerations – can sometimes take more than one day, said Dr. Belmont. The potential benefit of correcting major clinical abnormalities prior to hip fracture surgery can influence survival. This process often can be expedited when the orthopaedic surgeon works directly with the internal medicine physician or hospitalist who is helping to manage the patient.

"With the rising incidence of hip fractures, patient-treatment solutions directed toward this modifiable factor may reduce complications, and potentially, mortality," said Dr. Belmont.

Explore further: Regional anesthesia reduces complications and death for hip fracture patients

Related Stories

Regional anesthesia reduces complications and death for hip fracture patients

June 20, 2012
In a study of more than 18,000 patients having surgery for hip fracture, researchers at the Perelman School of Medicine at the University of Pennsylvania found that the use of regional anesthesia versus general anesthesia, ...

Undiagnosed neurological disorders may cause falls and hip fractures in the elderly

February 9, 2012
Hip fractures are a common cause of morbidity and mortality in elderly patients. Cervical myelopathy is a common neurological condition that can diminish balance and coordination.

Living in a sunny climate does not improve vitamin D levels in hip fracture patients

March 19, 2013
While it is well known that a majority of hip fracture patients of all ages and both sexes have insufficient or deficient levels of vitamin D, a new study presented today at the 2013 Annual Meeting of the American Academy ...

Risk factors ID'd for cervical spinal surgery complications

February 7, 2013
(HealthDay)—Risk factors have been identified for medical complications following cervical spine surgery, with cardiac and pulmonary complications correlating with death within two years, according to research published ...

Recommended for you

Co-infection with two common gut pathogens worsens malnutrition in mice

July 27, 2017
Two gut pathogens commonly found in malnourished children combine to worsen malnutrition and impair growth in laboratory mice, according to new research published in PLOS Pathogens.

Finish your antibiotics course? Maybe not, experts say

July 27, 2017
British disease experts on Thursday suggested doing away with the "incorrect" advice to always finish a course of antibiotics, saying the approach was fuelling the spread of drug resistance.

Phase 3 trial confirms superiority of tocilizumab to steroids for giant cell arteritis

July 26, 2017
A phase 3 clinical trial has confirmed that regular treatment with tocilizumab, an inhibitor of interleukin-6, successfully reduced both symptoms of and the need for high-dose steroid treatment for giant cell arteritis, the ...

A large-scale 'germ trap' solution for hospitals

July 26, 2017
When an infectious airborne illness strikes, some hospitals use negative pressure rooms to isolate and treat patients. These rooms use ventilation controls to keep germ-filled air contained rather than letting it circulate ...

Researchers report new system to study chronic hepatitis B

July 25, 2017
Scientists from Princeton University's Department of Molecular Biology have successfully tested a cell-culture system that will allow researchers to perform laboratory-based studies of long-term hepatitis B virus (HBV) infections. ...

Male hepatitis B patients suffer worse liver ailments, regardless of lifestyle

July 25, 2017
Why men with hepatitis B remain more than twice as likely to develop severe liver disease than women remains a mystery, even after a study led by a recent Drexel University graduate took lifestyle choices and environments ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.