Abstract
PurposeDementia, present in 20% of hip fracture patients, is associated with an almost threefold increase in postoperative mortality risk. These patients have a substantially higher incidence of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia. This study aimed to investigate the association between beta-blocker therapy and postoperative mortality in patients with dementia undergoing hip fracture surgery.MethodsThis nationwide study included all patients in Sweden with the diagnosis of dementia who underwent emergency surgery for a hip fracture between January 2008 and December 2017. Cases where the hip fracture was pathological or conservatively managed were not included. Poisson regression analysis with robust standard errors was performed while controlling for confounders to determine the relationship between beta-blocker therapy and all-cause, as well as cause-specific, postoperative mortality.ResultsA total of 26,549 patients met the study inclusion criteria, of whom 8258 (31%) had ongoing beta-blocker therapy at time of admission. After adjusting for clinically relevant variables, the incidence of postoperative mortality in patients receiving beta-blocker therapy was decreased by 50% at 30 days [adj. IRR (95% CI) 0.50 (0.45–0.54), p < 0.001] and 34% at 90 days [adj. IRR (95% CI) 0.66 (0.62–0.70), p < 0.001]. Cause-specific mortality analysis demonstrated a significant reduction in the incidence of postoperative cardiovascular, respiratory, and cerebrovascular death within 30 and 90 days postoperatively.ConclusionBeta-blocker therapy is associated with decreased postoperative mortality in hip fracture patients with dementia up to 90 days after surgery. This finding warrants further investigation.
Highlights
Beta‐blocker use Despite interventions and guidelines introduced during the past decade to reduce mortality, postoperative mortality has remained a constant challenge in managing hip fracture patients [1]
This study investigates the association between beta-blocker therapy and postoperative mortality in patients with dementia undergoing hip fracture surgery, with the hypothesis that beta-blocker therapy is associated with decreased mortality
All comorbidities were less prevalent in the beta-blocker therapy (BB)− cohort apart from metastatic carcinoma, which was prevalent in both cohorts (Table 2)
Summary
Beta‐blocker use Despite interventions and guidelines introduced during the past decade to reduce mortality, postoperative mortality has remained a constant challenge in managing hip fracture patients [1]. Approximately 20% of hip fracture patients have dementia, a condition independently associated with an almost threefold increase in postoperative mortality risk [2,3,4,5,6]. These patients have a substantially higher incidence of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia [7]. Several previous studies have demonstrated a positive association between beta-blocker therapy (BB) and a reduction in postoperative mortality after non-cardiac surgery, including in patients with isolated hip fractures [2, 9, 10, 16]. This study investigates the association between beta-blocker therapy and postoperative mortality in patients with dementia undergoing hip fracture surgery, with the hypothesis that beta-blocker therapy is associated with decreased mortality
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