Attributable Mortality of Hip Fracture in Older Patients: A Retrospective Observational Study.

Lorène Zerah,Frédéric Khiami,Yannick Le Manach,Mathieu Raux,Judith Cohen-Bittan,Jacques Boddaert,Bruno Riou,David Hajage,Anthony Mézière

doi:10.3390/jcm9082370

Abstract

Hip fracture (HF) in older patients is associated with a high six-month mortality rate. Several clinical conditions may affect outcome, including baseline characteristics, co-existing acute illnesses, perioperative factors, and postoperative complications. Our primary objective was to estimate the respective effect of these four domains on six-month mortality after HF. A retrospective observational study using a monocentric cohort of older patients was conducted. All patients ≥ 70 years old admitted to the emergency department for HF and hospitalized in our perioperative geriatric care unit from June 2009 to September 2018 were included. Among 1015 included patients, five (0.5%) were lost to follow-up, and 1010 were retained in the final analysis (mean age 86 ± 6 years). The six-month mortality rate was 14.8%. The six-month attributable mortality estimates were as follows: baseline characteristics (including age, gender, comorbidities, autonomy, type of fracture): 62.4%; co-existing acute illnesses (including acute events present before surgery that could result from the fracture or cause it): 0% (not significantly associated with six-month mortality); perioperative factors (including blood transfusion and delayed surgery): 12.3%; severe postoperative complications: 11.9%. Baseline characteristics explained less than two-thirds of the six-month mortality after HF. Optimizing patients care by improving management of perioperative factors and thus decreasing postoperative complications, could reduce by a maximum of one quarter of the six-month mortality rate after HF.

Highlights

Hip fracture (HF) is a major public health concern that has increasing socio-economic consequences [1]
The demonstration that a dedicated clinical action plan can significantly improve the six-month mortality of elderly patients with HF, compared to patients admitted to the orthopedic surgery department, is in favor of this hypothesis [9]
We searched on PubMed, on 1st March, 2018 and on 1st December, 2019, if a study had attempted to quantify the attributable mortality of HF in the elderly, without success (((attributable mortality[Title/Abstract]) Odds ratios (ORs)) AND)

Summary

Introduction

Hip fracture (HF) is a major public health concern that has increasing socio-economic consequences [1]. Its incidence is decreasing, the total number of HF cases is increasing in line with the aging population (more than 1.6 million people undergo hip fracture in the world every year) [2,3]. This frequent emergency condition is associated with a poor prognosis. As compared with elective total hip replacements, for HF patients, the mortality is increased 6- to 15-fold [6] This difference was thought to be explained by the high prevalence of pre-existing medical conditions in this population, which is known to be associated with poor medical outcomes [2,7,8,9]. We searched on PubMed, on 1st March, 2018 and on 1st December, 2019, if a study had attempted to quantify the attributable mortality of HF in the elderly, without success (((attributable mortality[Title/Abstract]) OR (averaged attributable fractions[Title/Abstract])) AND (hip fracture[Title/Abstract]))

Results

Discussion

Conclusion