Abstract
AimThe aim of this study was to investigate the association between Parkinson's disease (PD) and postoperative complications, mortality, and quality of in-hospital care in patients with hip fracture. MethodsWe included patients aged 65+ years with an incident hip fracture from 2004-2017, registered in the Danish Multidisciplinary Hip Fracture Registry. Patients with PD were identified using diagnosis codes prior to hip fracture. Using log-binomial regression, we calculated both 30-day crude and adjusted risk ratios (aRR) with 95% confidence intervals (CIs) for the following outcomes: any hospital-treated infections, pneumonia, urinary tract infection, sepsis, community-treated infections, cardiovascular events, mortality, and fulfilment of quality indicators of in-hospital care. Analyses were adjusted for age, sex and Charlson comorbidity index score. ResultsWe identified 77,550 hip fracture patients of which 1,915 had PD. Compared to non-PD, patients with PD had higher risk of any hospital-treated - (aRR = 1.27 (CI: 1.10-1.45) and community-treated infection (aRR = 1.22 (CI: 1.13-1.32)), pneumonia (aRR = 1.38 (1.11-1.69)), urinary tract infection (aRR of 1.58 (CI: 1.28-1.92)) and sepsis (aRR = 1.18 (CI: 0.67-1.89)), but a reduced risk of cardiovascular events (aRR = 0.59 (CI: 0.41-0.82)). The aRR for 30-day mortality was 1.11 (CI: 0.97-1.27) for PD vs non-PD patients, and the aHR for 1-year mortality was 1.19 (CI: 1.09-1.30). The aRRs for fulfillment of all relevant quality indicators was about 1 for PD vs non-PD patients. ConclusionHip fracture patients with PD have a higher risk of infections and mortality within 30 days after surgery after adjustment for sex, age, and comorbidity. They do, however, receive comparable quality of in-hospital care after hip fracture compared to non-PD patients.
Highlights
Parkinson’s disease (PD) is a chronic progressive neurodegenerative disease with increasing worldwide prevalence [1]
Patients with hip fracture have a high risk of developing a number of postoperative complications [7], including cardiovascular events [8] and infections [9] - especially pneumonia [10]
We identified those with PD before the date of hip fracture surgery using primary and/or secondary ICD-10 code: G20 in the Danish National Patient Registry (DNPR)
Summary
Parkinson’s disease (PD) is a chronic progressive neurodegenerative disease with increasing worldwide prevalence [1]. It is characterized by classic motor symptoms including rigidity and akinesia, slowness of movement and poor balance and coordination resulting in change in walking pattern [2]. Non-motor symptoms comprise cognitive decline and fatigue. These symptoms, combined with a high prevalence of osteoporosis, [3] make PD patients susceptible to osteoporotic fractures. It has been shown that patients with PD have 3-fold increased risk of sustaining a hip fracture compared to non-PD patients [4]. Patients with hip fracture have a high risk of developing a number of postoperative complications [7], including cardiovascular events [8] and infections [9] - especially pneumonia [10]
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