Abstract
BackgroundThe poor outcome after a hip fracture is not fully understood.The aim of the study was to describe the prevalence of co-morbidities, complications and causes of death and to investigate factors that are able to predict mortality in old people with femoral neck fracture.MethodsData was obtained from a randomized, controlled trial with a 3-year follow-up at Umeå University Hospital, Sweden, which included 199 consecutive patients with femoral neck fracture, aged ≥70 years. The participants were assessed during hospitalization and in their homes 4, 12 and 36 months after surgery. Medical records and death certificates were analysed.ResultsMultivariate analysis revealed that cancer, dependence in P-ADL (Personal Activities of Daily Living), cardiovascular disease, dementia at baseline or pulmonary emboli or cardiac failure during hospitalization were all independent predictors of 3-year mortality. Seventy-nine out of 199 participants (40 %) died within 3 years. Cardiovascular events (24 %), dementia (23 %), hip-fracture (19 %) and cancer (13 %) were the most common primary causes of death. In total, 136 participants suffered at least one urinary tract infection; 114 suffered 542 falls and 37 sustained 56 new fractures, including 13 hip fractures, during follow-up.ConclusionOld people with femoral neck fracture have multiple co-morbidities and suffer numerous complications. Thus randomized intervention studies should focus on prevention of complications that might be avoidable such as infections, heart diseases, falls and fractures.
Highlights
The poor outcome after a hip fracture is not fully understood
Predictors of mortality A history of cardiovascular disease, cancer, dependence in personal activities of daily living (P-ADL), dementia, having three or more co-morbidities, dependence in walking, having an American Society of Anaesthesiologists (ASA) score of 3 or higher, living in residential care facilities, male gender, depression and pulmonary disease were all independently associated with time to death in univariate Cox regression analyses (Table 1)
The hazard ratios (HR) and 95 % confidence intervals (CI) are presented for the significant variables remaining in the multivariate models
Summary
The poor outcome after a hip fracture is not fully understood. The aim of the study was to describe the prevalence of co-morbidities, complications and causes of death and to investigate factors that are able to predict mortality in old people with femoral neck fracture. Hip fractures are a common and major health problem among older people [1]. There is a well-established increased risk of death after hip fracture [3, 4]. It has been shown that older people have a 5- to 8-fold increased risk of dying during the first 3 months after a hip fracture [4]. Studies have been performed to optimize care of hip fracture patients and the consensus concerning preoperative management, time to surgery, operative management, surgical technique and postoperative care has led to. One study found that 33 % of the participants had at least one complication after an operation for hip-fracture which led to prolonged hospitalization. Another study found heart failure and chest infections to be the most common postoperative complications [12], while a Berggren et al BMC Geriatrics (2016) 16:120 more recent study showed that falls, fractures and pneumonia were the most common [13]
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