Abstract
Fragility hip fracture is a common condition with serious consequences. Most outcomes data come from Western and Asian populations. There are few data from African and Middle Eastern countries. The primary objective was to describe mortality rates after fragility hip fracture in a Level-1 trauma centre in Egypt. The secondary objective was to study the causes of re-admissions, complications, and mortality. A prospective cohort study of 301 patients, aged > 65 years, with fragility hip fractures. Data collected included sociodemographic, co-morbidities, timing of admission, and intraoperative,ostoperative, and post-discharge data as mortality, complications, hospital stay, reoperation, and re-admission. Cox regression analysis was conducted to investigate factors associated with 1-year mortality. In-hospital mortality was 8.3% (25 patients) which increased to 52.8% (159 patients) after one year; 58.5% of the deaths occurred in the first 3-months. One-year mortality was independently associated with increasing age, ASA 3-4, cardiac or hepatic co-morbidities, trochanteric fractures, total hospital stay, and postoperative ifection and metal failure. Our in-hospital mortality rate resembles developed countries reports, reflecting good initial geriatric healthcare. However, our 3- and 12-months mortality rates are unexpectedly high. The implementation of orthogeriatric care after discharge is mandatory to decrease mortality rates.
Highlights
A fragility fracture is defined by the World Health Organization as "a fracture caused by an injury that would be insufficient to fracture a normal bone as a result of reduced compressive and/or torsional strength of bone"[1]
Fragility hip fractures considered as a significant public health concern mostly associated with increased morbidity as well as mortality compared to other osteoporos related fractures[17, 18], prolonged recumbency related complications mainly deep vein thrombosis, pulmonary embolism, and pneumonia, which may occur during hospitalization or even after patients discharge had been considered as the leading causes for increased mortality rates[18,19,20]
We found that age, advanced ASA grade (3 or 4), associated cardiac or hepatic disease, trochanteric fractures, post-operative infection or metal failure, and length of hospital stay were significantly associated with mortality
Summary
A fragility fracture is defined by the World Health Organization as "a fracture caused by an injury that would be insufficient to fracture a normal bone as a result of reduced compressive and/or torsional strength of bone"[1]. Apart from increasing mortality, a high percentage of physical and mental morbidities with increasing disability, loss of independence, and increased level of institutionalization may follow[10,11,12] This explains the high amount of health and socioeconomic burdens posed by this problem[13, 14]. To the best of our knowledge there was no detailed mortality rate report after fragility hip fractures from our area (Africa and the Middle East) in the past five years. One-year mortality was independently associated with increasing age, ASA 3-4, cardiac or hepatic co-morbidities, trochanteric fractures, total hospital stay, and postoperative ifection and metal failure.
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