Hip Fracture Mortality Research Articles

Effect of Nonsurgical Versus Surgical Management on Geriatric Hip Fracture Mortality of Hispanic-American Male Veterans.

IntroductionThe effect of surgical vs nonsurgical management on hip fracture mortality of Hispanic-American male veterans has not been rigorously studied. Hence, we examined the mortality and life expectancy effect of nonsurgical vs surgical management after hip fracture in a geriatric Hispanic-American male veterans’ population.Material and MethodsThis was a retrospective cohort study of Hispanic-American male veterans who were 65 years of age or older and suffered a femoral neck or intertrochanteric fracture from January 2008 to December 2015. Analysis between a surgical cohort (cannulated screw fixation, hemiarthroplasty, total hip arthroplasty, or cephalomedullary nail) and a non-surgical cohort was performed. In-hospital, 30-day, one-year, and two-year mortality were compared between both groups.ResultsOut of 268 patients with hip fracture, 159 (59.2%) were treated surgically and 109 (40.8%) non-surgically. The overall in-hospital (9.2% vs 1.9%, P = .009), 30-day (17.4% vs 5.0%, P = .002), one-year (48.6% vs 23.3%, P < .001), and two-year (63.3% vs 36.5%, P < .001) mortality rate was found to be higher for the nonoperative group. The average life expectancy of the nonoperative cohort was significantly shorter than those who were managed surgically (216 days vs 260 days, P < .001).Discussion and ConclusionThis study shows a higher mortality rate and lower life expectancy in geriatric male patients who were treated nonsurgically in a Veterans Health Affair hospital facility that mostly serves Hispanic-American veterans. Our results provide an expansion to the findings of other geriatric studies on hip fracture with focus in a Hispanic-American veteran male population.

A novel machine-learning algorithm for predicting mortality risk after hip fracture surgery.

Although several risk stratification models have been developed to predict hip fracture mortality, efforts are still being placed in this area. Our aim is to (1) construct a risk prediction model for long-term mortality after hip fracture utilizing the RSF method and (2) to evaluate the changing effects over time of individual pre- and post-treatment variables on predicting mortality. 1330 hip fracture surgical patients were included. Forty-five admission and in-hospital variables were analyzed as potential predictors of all-cause mortality. A random survival forest (RSF) algorithm was applied in predictors identification. Cox regression models were then constructed. Sensitivity analyses and internal validation were performed to assess the performance of each model. C statistics were calculated and model calibrations were further assessed. Our machine-learning RSF algorithm achieved a c statistic of 0.83 for 30-day prediction and 0.75 for 1-year mortality. Additionally, a COX model was also constructed by using the variables selected by RSF, c statistics were shown as 0.75 and 0.72 when applying in 2-year and 4-year mortality prediction. The presence of post-operative complications remained as the strongest risk factor for both short- and long-term mortality. Variables including fracture location, high serum creatinine, age, hypertension, anemia, ASA, hypoproteinemia, abnormal BUN, and RDW became more important as the length of follow-up increased. The RSF machine-learning algorithm represents a novel approach to identify important risk factors and a risk stratification models for patients undergoing hip fracture surgery is built through this approach to identify those at high risk of long-term mortality.

Performance Status Modifies the Association Between Vitamin D Receptor Activator and Mortality or Fracture: A Prospective Cohort Study on the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry.

Immobilization osteoporosis is characterized by excess bone resorption. Vitamin D receptor activators (VDRA) might have adverse effects in immobilized patients. The objective of this study was to elucidate the impact of performance status (PS) on the associations between VDRA use and outcomes among hemodialysis patients. This is a prospective cohort study. Adults on hemodialysis in the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry were included. Exposure of interest was the use of VDRA. Outcomes were all-cause mortality and hip fracture. Associations between VDRA use and mortality or hip fractures were examined by Cox and Poisson regression analyses, respectively. Among 208,512 subjects, 128,535 were on VDRA. Poor PS was associated with higher calcium (Ca), lower parathyroid hormone, and higher alkaline phosphatase levels. The association between higher Ca levels and VDRA use was stronger among those with poor PS (p interaction 0.007). Adjusted hazard ratio (HR) (95% confidence interval [CI]) for mortality and incidence rate ratio (IRR) for hip fracture was 1.02 (95% CI, 0.99-1.05) and 0.93 (0.86-1.00) among users of VDRA, respectively. The VDRA use was associated with lower mortality and incidence of hip fractures among subjects with good PS but not among subjects with poor PS (p interaction 0.03 and 0.05). Effect modification by PS was observed for cardiovascular (CV) mortality but not for non-CV mortality. In conclusion, VDRA use was associated with better outcomes only among those with good PS. These results suggest that bone and mineral disorders among hemodialysis patients should be treated differently, depending on their performance status. © 2022 American Society for Bone and Mineral Research (ASBMR).

The effects of COVID‐19 on hip fracture management and mortality in a regional trauma centre

Older patients and those with comorbidities have worse outcomes from both hip fracture and COVID-19. Furthermore, testing positive for COVID-19 can increase mortality for any surgical procedure [1]. In anticipation of the initial COVID-19 surge, theatre staff were re-allocated in order to meet the expected increase in local critical care bed requirements, resulting in reduced capacity to deliver surgical services. We analysed the impact of the initial COVID-19 surge on the hip fracture population in a high-volume tertiary trauma centre (approximately 900 hip fracture surgical procedures per year) in the UK [2]. The study included a 2-month period following the onset of lockdown from 24 March 2020 until 23 May 2020, and we compared this with the same 2-month time period in 2015–2019. This included patients aged > 60 years who were admitted with a hip fracture. It did not include patients with high-energy injuries, pathological fractures and those who underwent surgery in other units before admission. Data were retrieved from the hospital’s inpatient fracture database, the Fracture Outcomes Research Department, which contributes to the National Hip Fracture Database [2]. The study was approved by the Belfast Trust’s Quality Improvement and Patient Safety Department. During the study period in 2020, 126 hip fracture patients were included, compared with an average of 115 patients per year in 2015–2019. This suggests that, despite nationwide advice to avoid unnecessary social contact and remain at home where possible, a cohort of patients continued to fall and sustain hip fractures. Looking specifically at the 2020 cohort (Table 1), 68.0% of patients were aged 80 or above, and 86.9% of those operated on were deemed ASA physical status 3 or worse. These patients clearly remain at significant risk of sustaining a fall and subsequent hip fracture, despite the COVID-19 lockdown restrictions. 2020 n = 126 2015–2019 n = 574 Aerosol generating procedures were avoided where possible in 2020, with an increased use of neuraxial over general anaesthesia demonstrated (p < 0.001) [3]. However, this result may be confounded due to a general trend towards neuraxial anaesthesia within the department in the last 5 years (Fig. 1). Time to theatre improved during the pandemic, despite a reduction in theatre capacity (time to theatre < 48 h was 64.2% in 2020 compared with 53.6% in 2015–2019, p = 0.03). The 30-day mortality in 2020 was also similar to that of 2015–2019 for both surgically and conservatively managed patients. This highlights the ability to maintain high standards of care despite the organisational changes made during surge planning. A total of 7.1% patients tested positive for COVID-19, all of whom were operated on (9/126 positive, 113/126 negative, 4/126 no result). The 30-day mortality rate of COVID-19-positive patients was 22.0%, compared with 2.7% in COVID-19-negative patients (p = 0.05) and corroborates broadly with the findings of a number of other publications [4, 5]. [Correction added 18 January 2021, after first online publication: the first sentence in this paragraph has been corrected in this version] Our results demonstrate the ability to maintain an effective hip fracture service with largely unchanged outcomes during the height of the COVID-19 pandemic. Strengths of the study included robust follow-up and the ability to compare our results with retrospective pre-pandemic data. There were substantially lower numbers of patients with COVID-19 in Northern Ireland when compared with the rest of the UK, which may limit the generalisability of the results; however, it is possible that these lower numbers may more closely represent future surges. Our study showed increased mortality in COVID-19-positive patients undergoing surgical management, which may raise ethical considerations for this cohort. The inclusion of only nine COVID-19-positive patients and the high rates of spinal anaesthesia may limit conclusions, with further research warranted to answer questions such as the timing of surgery in COVID-19-positive patients who require hip fracture surgery.

Osteoporotic hip fracture mortality and associated factors in Hawai'i.

The objective of this study was to evaluate mortality and factors associated with mortality of osteoporotic hip fracture patients at community hospitals within a large healthcare system in Hawai'i. A retrospective chart review was conducted of 428 patients, ≥50years, and hospitalized for a osteoporotic hip fracture from January 2015 to May 2016 within a large healthcare system in Hawai'i. Patient demographics, comorbidities, and treatment were collected from retrospective chart review. We determined the date of death by review of medical records and online public obituary records. We calculated 30-day, 90-day, 1-year, 2-year, and 3-year mortality after discharge for hip fracture admission. Multivariable logistic regression and proportional hazards regression were used to evaluate associations between variables and the mortality of the patients. The 30-day and 90-day mortality after admission for hip fracture were 4.2% and 8.6%. One-year mortality, 2-year mortality, and 3-year mortality were 17.1%, 24.5%, and 30.1%, respectively. Through proportional hazards regression, older age (hazard ratio (HR) = 1.06, p < 0.001), high comorbidity load (HR = 1.30, p < 0.001), and primary insurance status-Medicare/Medicaid (HR = 3.78, p = 0.021) were associated with increased mortality, while female sex (HR = 0.54, p < 0.001) and higher BMI (HR = 0.94, p = 0.002) were associated with lower mortality. After admission for osteoporotic hip fracture, the 30-day mortality was 4.2%. At 1year, 2years, and 3years, mortality increased to 17.1%, 24.5%, and 30.1%, respectively. Increased age, male sex, higher Charlson comorbidity index score, primary insurance status-Medicare/Medicaid, and lower body mass index were associated with increased mortality.

Obesity is associated with early hip fracture risk in postmenopausal women: a 25-year follow-up

SummaryAssociation of body mass index and hip fracture has been controversial. In this study, women with lowest and highest body weight had the highest fracture incidence. A 25-year follow-up indicated that obesity associates with early hip fracture risk and suggested increasing trend in normal-weight women at a later stage.IntroductionObesity is a pandemic health issue. Its association with hip fracture risk remains controversial. We studied the long-term relationship of body mass index and hip fracture incidence in postmenopausal women.MethodsThe cohort of 12,715 Finnish women born in 1932–1941 was followed for 25 years, covering ages from 58 up to 83. Fractures and deaths were obtained from national registries. Women were investigated in deciles of BMI as well as in WHO weight categories (normal, overweight, or obese). The follow-up analysis was carried out in two age strata as “early” (58–70 years) and “late” (> 70 years). Body weight information was updated accordingly. Femoral neck BMD was recorded for a subsample (n = 3163). Altogether, 427 hip fractures were observed.ResultsA higher risk of early hip fracture was observed in obese and normal-weight compared with overweight women with hazard ratios (HRs) of 2.3 ((95% CI) 1.4–3.7) and 2.0 (1.3–3.1) while no difference was observed in late hip fracture risk between the three WHO categories (log rank p = 0.14). All-cause mortality during the follow-up was 19.3%. Compared with normal weight women, the obese women had a higher risk of death with an HR of 1.6 (1.4–1.8) and higher baseline BMD (p < 0.001). Faster bone loss was observed in the obese compared with other women (p < 0.001).ConclusionObesity associates with earlier hip fracture and higher postfracture mortality. The obese women with low BMD have clearly the highest risk of hip fracture. This combination increases hip fracture risk more than either of the factors alone. After 75 years of age, risk appears to increase more in normal weight women, but this trend is in need of further confirmation.

Is 48 h a critical cut-off point for mortality in geriatric hip fractures?

Background/aimIn this study, our objective was to evaluate the mortality in geriatric hip fracture patients who were operated within 48 h after admission or after the 48th h.Materials and methodsA total of 194 patients who had undergone surgery for hip fracture between 2016 and 2018 were retrospectively evaluated. Patient information was obtained from the hospital’s database using the ICD codes 81.52, 82.00–82.09, and 82.10. Radiological examination reports were collected from the patient files. Information on mortality was obtained from the Death Notification System of the Turkish Ministry of Health. First-year mortality rates of patients operated within 48 h (Group 1) and those operated at 48–96 h (Group 2) were compared.ResultsThe mean duration between admission to the hospital and surgical intervention was 33.90 ± 1.95 h (3–96 h). The mean total hospitalization time was 7.29 ± 1.53 days (2–36 days). Of the patients, 62 (32%) died within one year after the operation. The mean survival times for patients operated ≤48 h or >48 h were 8.47 ± 1.90 and 6.57 ± 2.59 months, respectively (Z = 1.074, P = 0.283). There was no significant correlation between survival time and the time delay before the operation (r = –0.103, P = 0.153). Additionally, the Cox regression analysis, including age (years), ASA (grade 3 vs. 2), time to operation (h), and days spent in the ICU, demonstrated no significant independent effect of the time to operation on survival (P = 0.200).ConclusionAlthough shortening the time to surgery may have some rationale, we did not find any difference in patients operated before 48 h compared to 48–96 h concerning mortality.

Mortality in hip fractures: Stratifying the risk of operative delay and quantifying the benefit of early mobilisation.

Early mortality following hip fracture surgery remains a significant issue with a much studied, multifactorial aetiology. This study designed to test the variables affecting 30 day mortality in a socially deprived cohort against national models, and secondarily aimed to uncover and quantify new risk factors. This was a single centre retrospective study based on National Hip Fracture Database (NHFD) data for 3176 hip fracture patients from 1st May 2008 to December 31st 2017.Data was condensed into a single anonymised workbook and logistic regression used to analyse associations with 30 day mortality. Firstly, the 6 casemix variables used by the NHFD were modelled. Secondarily, a new optimised model based on our data was created. Gross mortality was 11.1% since May 2008 (344/3074). There were 1978 patients in our cohort with sufficient data to run the NHFD casemix model. Overall, this proved fair with a similar area under ROC curve to nationally (0.75vs. 0.76), although the Odds Ratios (OR) of individual variables differed. The optimised casemix model suggested two powerful prognostic indicators for 30 day mortality, namely delay to theatre for clinical reasons (OR =3.98, p-value=0.02) and whether the patient was mobilised day one post op (OR=0.21, p-value=0.00).Delay to theatre for non clinical reasons conveyed only a marginal and statistically insignificant increase in risk (OR=1.15, p-value=0.77). This study has confirmed the NHFD casemix adjusted model is a fair barometer for units treating a socially deprived cohort. It also has shown a clear differentiation between risk conveyed by delay to theatre for clinical reasons and suggests delay for non-clinical reasons, although clearly not desired, may not have a significant effect on death rate. Finally, it both amplifies and prompts further investigation into the potential benefit of early mobilisation.

Is the number of previous hospitalizations associated with increased in-hospital mortality after hip fracture in a developing country?

We aimed to examine whether the number of previous hospitalizations and the main diagnoses of those hospitalizations are associated with increased in-hospital hip fracture mortality for older people. That assessment is relevant because if those variables are shown to be associated with increased mortality, that finding could support their use as proxies for comorbidity burden for case-mix adjustment in statistical models seeking to compare the performance of hospitals regarding hip fracture mortality in settings with limited hospital information systems. In this retrospective cohort study of all public hospital admissions for older adults with hip fractures in the city of Rio de Janeiro between 2010 and 2011, we used data from the Hospital Admission Information System database to examine the association between in-hospital mortality and the number of hospitalizations in the previous two years and their main diagnoses through logistic regression. Among 1938 patients included in the study there were 103 (5.3%) in-hospital deaths. Although the presence of hospitalization episodes within the two years preceding the index hip fracture was associated with increased mortality (OR: 1.78, 95%CI: 1.07 to 2.97) we did not find evidence of a gradient of increased mortality with a growing number of previous hospitalizations. Additionally, several diseases recorded as main diagnoses of previous hospitalizations were not associated with increased mortality rates, as was expected based on existing knowledge on risk factors for decreased survival in older adults with hip fractures. Our results suggest that, in settings where local hospital information systems have limited access to secondary diagnoses, the use of the number of previous hospitalizations or the main diagnoses associated with those hospitalizations as proxies for the profile of comorbidities of older adults with hip fractures may not be an effective way to adjust for case-mix when comparing in-hospital mortality rates among hospitals.

Randomized Trial Evaluation of the Benefits and Risks of Menopausal Hormone Therapy Among Women 50–59 Years of Age

The health benefits and risks of menopausal hormone therapy among women aged 50-59 years are examined in the Women's Health Initiative randomized, placebo-controlled trials using long-term follow-up data and a parsimonious statistical model that leverages data from older participants to increase precision. These trials enrolled 27,347 healthy postmenopausal women aged 50-79 years at 40 US clinical centers during 1993-1998, including 10,739 post-hysterectomy participants in a trial of conjugated equine estrogens and 16,608 participants with a uterus in the trial of these estrogens plus medroxyprogesterone acetate. Over a (median) 18-year follow-up period (1993-2016), risk for a global index (defined as the earliest of coronary heart disease, invasive breast cancer, stroke, pulmonary embolism, colorectal cancer, endometrial cancer, hip fracture, and all-cause mortality) was reduced with conjugated equine estrogens with a hazard ratio of 0.82 (95% confidence interval: 0.71, 0.95), and with nominally significant reductions for coronary heart disease, breast cancer, hip fracture, and all-cause mortality. Corresponding global index hazard ratio estimates of 1.06 (95% confidence interval: 0.95, 1.19) were nonsignificant for combined estrogens plus progestin, but increased breast cancer risk and reduced endometrial cancer risk were observed. These results, among women 50-59 years of age, substantially agree with the worldwide observational literature, with the exception of breast cancer for estrogens alone.

Development of a Mortality Risk Model in Elderly Hip Fracture Patients by Different Analytical Approaches

Hip fracture is a major health issue that accompanies community aging. The most critical time after a hip fracture should be the first year. Care systems and surgical techniques for hip fractures have improved, so the trend of mortality in elderly hip fracture could be changed with them. Therefore, we observed the changes in the trend and critical factors for first-year mortality for the hip fractures in an elderly population in Taiwan, and mortality of prognosis prediction model was developed for the early diagnosis using a population-based database in Taiwan (National Health Insurance Research Database, NHIRD). A total of 166,274 elderly subjects with an age greater than 60-years-old from 2001 to 2010 were collected for this study. Cox proportional-hazards (PH) regression and logistic regression were calculated to odds ratio and hazard ratio for mortality of those patients and compared it. Data mining algorithms were also used to generate a risk stratification prediction model. The first-year mortality rate of the overall study group was 21.5% in 2001 and 15.0% in 2010 (p for trend &lt; 0.001). In the male subgroup, the first-year mortality rate was 29.3% in 2001 and decreased to 17.3% in 2010; the trend of standardized mortality ratio was significantly decreased from 4.4 to 2.6 (p for trend &lt; 0.001). By logistic regression, mortality significantly increased with age and male gender. Furthermore, gender, age, patients with diabetes mellitus (DM), cardiovascular (CV), and renal comorbidity, and surgical intervention can be variables for constructing the risk stratification model. The findings of the study will be used for helping related field physicians to predict the prognosis risk of hip fracture patients, and provide evidence-based tailored treatment recommendations for those patients. It may consider to build various models for predicting the prognosis of hip fracture or integrating prediction algorithms into the computerized physician order entry system, thus creating a practical clinical decision support system with warning functions.

Nonagenarian hip fractures: Morbidity and mortality at a single institution

ObjectivesThe incidence of hip fractures continues to rise dramatically, but few studies have examined these injuries in the population of individuals over 90 years of age, which is one of the fastest growing populations. We present the largest such study specifically examining hip fractures in the super-elderly. MethodsA review of 216 hip fracture patients over 90 years of age were examined for immediate postoperative complications and in-house, 30-day, and 1-year mortality. ResultsOverall 1-year mortality was 38.1%. Statistically-significant risk factors for 1-year mortality included oncologic fracture, dementia, and CHF. Fracture classification and hospital length of stay were associated with perioperative complications including anemia and pneumonia. ConclusionThe nonagenarian hip fracture is associated with a higher 1-year mortality than prior reported rates of mortality for elderly hip fractures. Factors previously reported to influence the risk of 1-year mortality in hip fractures are not observed in the super-elderly.

Incidence, morbidity and mortality of hip fractures over a period of 20 years in a health area of Southern Spain.

ObjectiveTo evaluate the incidence of osteoporotic hip fracture in the Macarena Health Area (Seville).Setting and participantsThis was a prospective observational study that collected all osteoporotic hip fractures that occurred between March 2013 and February 2014 at the Clinical Unit of Traumatology and Orthopaedics. All cases collected during the first 6 months of the study were followed for 1 year after the occurrence of the event.Outcome measuresWe evaluated the incidence of osteoporotic hip fractures in the Macarena Health Area (Seville) from 1 March 2013 to 28 February 2014, and we compared the incidence with that in 2 previous studies carried out with the same methodology in 1994 and 2006. Furthermore, we calculated the morbidity and degree of disability 1 year after the fracture occurred and determined mortality and the associated factors.ResultsThe overall incidence was 228 per 100 000 individuals/year (95% CI 204.5 to 251.6), and the incidence was higher in women than in men. In women, the incidence rate decreased in all age groups over time, while in men, the incidence rate increased. The mortality rate 1 year after the episode was 27.2%. The factors associated with overall mortality were a body mass index below 25 kg/m2, renal failure and low plasma proteins.ConclusionsOur results show a high incidence of osteoporotic hip fracture that is increasing in men, and in men it is associated with a higher mortality than in women. There is room to improve the modifiable factors associated with mortality and the available rehabilitation interventions to reduce the disability associated with these fractures.

Rural, urban, and teaching hospital differences in hip fracture mortality

IntroductionHip fractures remain one of the most prevalent and deadly conditions afflicting those 65 years and older. For other health conditions (e.g. myocardial infarction), hospital location is associated with poorer health outcomes. To our knowledge, no study has investigated the relationship between hip fracture morality rate in the United States between urban and rural hospital settings. MethodsA retrospective cohort study was conducted to examine differences in in-hospital mortality between groups treated in rural, urban-teaching, and urban-non-teaching hospitals, as well as public and private hospitals. Mortality rates were also compared for variances between surgical treatment, sex, insurance, patient location, race, and income. Discharge data was collected for 256,240 inpatient stays from the 2012 National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. ResultsOdds of mortality were 14.6% greater in rural hospital hip fracture patients compared to Urban/Non-Teaching centers (p < 0.05). ConclusionsResults from this study lend support to necessitate further research investigating prospective barriers to care of those in rural settings. This may point to limitations in resources and trained medical and surgical specialists in rural hospitals and need for continued research to mitigate such findings.

Length of Hospital Stay for Hip Fracture and 30-Day Mortality in People With Alzheimer's Disease: A Cohort Study in Finland.

BackgroundPersons with Alzheimer’s disease (AD) are at higher risk of hip fractures (HFs) than general older population and have worse prognosis after HF. Hospital stays after HF have shortened along time. We investigated the association between length of hospital stay after HF and mortality after discharge among persons with AD.MethodThe MEDALZ cohort includes all Finnish community dwellers who received clinically verified AD diagnosis in 2005–2011 (N = 70 718). Patients who experienced first HF after AD diagnosis in 2005‒2015 (n = 6999) were selected. Length of hospital stay for HF was measured as a sum of the consecutive days spent in hospital after HF until discharge. Outcome was defined as death within 30 days after hospital discharge.ResultsMean of overall length of hospital stay after a HF decreased from 52.6 (SD 62.9) days in 2005 to 19.6 (SD 23.1) days in 2015. Shortest treatment decile (1‒4 days) had the highest risk of death within 30 days after discharge (adjusted hazard ratio [aHR] 2.76; 95% confidence interval [CI] 1.66–4.60) in addition to second (5‒6 days; aHR 2.52; 95% CI 1.50–4.23) and third (7‒10 days; aHR 2.22; 95% CI 1.34–3.69) deciles when compared to the sixth decile of length of stays (21‒26 days).ConclusionsAmong persons with AD, shorter length of hospital stay after HF was associated with an increased risk of death after discharge. After acute HF treatment, inpatient rehabilitation or proper care and services in home need to be organized to older persons with AD.

Comparison of morbidity and mortality of hip and vertebral fragility fractures: Which one has the highest burden?

ObjectivesHip fragility fractures were regarded as one of the most severe, but recent papers report on the underestimated burden of vertebral compression fractures. This study aims to compare morbidity and mortality of hip and vertebral fragility fractures in patients treated in the same setting. MethodsPatients aged ≥50 years with hip fracture, and those with vertebral fracture presenting to our hospital between January 2014 and January 2017 were included. Patients were evaluated 1 year after their index fracture. SF-36 scores, mortality, and institutionalization are then recorded. Patients were divided into 2 groups: hip fractures and vertebral fractures. ResultsThere were 106 and 90 patients respectively evaluated in hip and vertebral fracture groups at 1 year. Patients in both groups were comparable for age, sex, comorbidities and neuropsychiatric condition (P > 0.05). At 1 year follow-up, SF-36 showed better averages in all 8 scales in hip fracture group compared to vertebral fracture group. Mortality in the hip fracture group reached 32.1% compared to 10% for the vertebral fracture group (P < 0.01). Fifteen patients were institutionalized in the hip fracture group compared to 18 patients in the vertebral fracture group (P > 0.05). ConclusionsWhen comparing patients treated in the same setting, hip fracture is associated with significantly increased mortality than vertebral fracture; however, the latter is associated with more morbidity.

Time to surgery and transfer-associated mortality for hip fractures in Western Australia.

Transfer time for patients with fractured hips is a significant problem in Australia. Current guidelines support operative management of hip fractures within 48 h with delays to surgery resulting in worse outcomes. The aim of study is to evaluate transfer times and delays and their effect on outcomes. A total of 506 hip fractures undergoing surgical management were reviewed between 2017 and 2018 at a tertiary metropolitan hospital. We examined age, time to surgery, transfer time, delay to surgery, American Society of Anesthesiologists grading and 30-day and 1-year mortality. We directly compared outcomes between patients presenting initially to the tertiary hospital and those who were referred from a peripheral site requiring inter-hospital transfer. The mean time to surgery was 24.4 h. Ninety-five percent of patients received their emergency surgery within 48 h with inter-hospital transfer patients delayed on average only by 12.08 h when compared to primary presenters. Patients who received their surgery in more than 48 h had worse mortality outcomes. Inter-hospital transfer, regardless of time to surgery, was associated with increased mortality. Increased time to surgery was associated with increased mortality rates. Transfer delays from a peripheral hospital had a significant bearing on time to surgery. Transfer, regardless of time to surgery, is associated with increased mortality. Early transfer to a referral hospital or bypass of the peripheral hospital is recommended.

Epidemiology of hip fracture and the development of a FRAX model for Uzbekistan

SummaryA prospective population-based survey in a region of the Republic of Uzbekistan determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX® model to facilitate fracture risk assessment in Uzbekistan.ObjectiveThis paper describes the epidemiology of hip fracture in the Republic of Uzbekistan that was used to develop a country-specific FRAX® tool for fracture prediction.MethodsDuring a 1-year (2016/17) prospective population-based survey in the Pap district of the Republic of Uzbekistan, hip fractures were prospectively identified from hospital registers, trauma centres and primary care and community sources. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Uzbekistan. Fracture probabilities were compared with those from neighbouring Kazakhstan and Kyrgystan.ResultsApproximately 41% of hip fracture cases did not come to medical attention, and two thirds of patients overall were not admitted to hospital. The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 16,764 and is predicted to increase more than three-fold to 60,272 in 2050. FRAX-based probabilities were higher in Uzbekistan than Kazakhstan or Kyrgystan.ConclusionThe FRAX model should enhance accuracy of determining fracture probability among the Uzbek population and help guide decisions about treatment.

Admission neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio to predict 30-day and 1-year mortality in geriatric hip fractures

IntroductionElderly patients with hip fractures exhibit a high incidence of mortality and morbidity. The aim of this study was to evaluate the factors that may predict mortality in patients with geriatric hip fracture. MethodsIncluded in this retrospective study were 241 patients who were admitted to the hospital with hip fractures between May 2017 and March 2019. The effect of the modified 5-item frailty index (mFI-5) on 30-day and 1-year mortality was evaluated. In addition, admission neutrophil-to-lymphocyte ratios (NLRs) and monocyte-to-lymphocyte ratios (MLRs) were also examined. ResultsThe mFI-5 was not found to be a statistically significant predictive indicator for 30-day and 1-year mortality (P = 0.485 and P = 0.484, respectively). Chronic obstructive pulmonary disease or current pneumonia was found to increase mortality by 2.702 times (P = 0.002). The 30-day mortality rates of patients aged ≥80 years were significantly higher than those aged 65–79 years (P < 0.05). However, there was no statistical difference in the mortality rates between the age groups after 30 days postoperatively (P = 0.114). Admission NLRs and MLRs were significantly higher in the 30-day and 1-year mortality groups. The cut-off values of the admission NLRs and MLRs for 30-day mortality were calculated as 6.55 and 0.65, respectively, while the same cut-off values for 1-year mortality were calculated as 6.55 and 0.635, respectively. ConclusionsAdmission NLRs and MLRs are useful hematological data for the prediction of 30-day and 1-year mortality in geriatric hip fracture patients.

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

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.