Hip fractures: mortality and correlation with preoperative comorbidities in Indian elderly population
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20214186Keywords:
Mortality, Hip fracture, Pre-operative comorbidityAbstract
Background: Hip fractures are an emerging health care problem due to increase in the elderly population all over the world and the associated complications, morbidity and mortality. The objective of this study is to find out the mortality rates in Indian elderly population with hip fractures and to establish an association between various related complications pre and post operatively for a better risk stratification.
Methods: A prospective observational cohort study, was carried out at a high-volume orthopaedic centre from 2009 to 2018. And all patients managed for hip fractures were followed up till death or 05 years.
Results: The age adjusted first-year mortality was found to be 33% with statistically significant increase in the mortality in individuals with three or more pre-op comorbidities. The significantly associated co-morbidities were chronic renal failure (Hazard ratio 2.32 with CI 1.65- 3.24) and diabetes mellitus (Hazard ratio 1.66 with CI 1.25 – 2.21). There has been a significant dip in the cumulative survival rates of these individuals irrespective of age, sex, preop anaemia.
Conclusions: A knowledge about the comorbidities/ risk factors and the extent to which they influence the long-term survival in the geriatric hip fracture patients can help treating physician to effectively prioritise and plan management in coordination with allied specialities.
References
Mithal A, Bansal B, Kyer CS, Ebeling P. The Asia-Pacific Regional Audit-Epidemiology, Costs, and Burden of Osteoporosis in India 2013: A report of International Osteoporosis Foundation. Indian Journal of Endocrinology and Metabolism. 2014;18(4):449-54.
Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian Journal of Orthopaedics. 2011;45(1):15-22.
Hirose J, Ide J, Irie H, Kikukawa K, Mizuta H. New Equations for Predicting Postoperative Risk in Patients with Hip Fracture. Clinical Orthopaedics and Related Research. 2009;467(12):3327-33.
Hommel A, Ulander K, Bjorkelund KB, Norrman PO, Wingstrand H, Thorngren KG. Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury. 2008;39(10):1164-74.
Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury. 2008;39(10):1157-63.
Pedersen SJ, Borgbjerg FM, Schousboe B, Pedersen BD, Jorgensen HL, Duus BR, et al. A comprehensive hip fracture program reduces complication rates and mortality. Journal of the American Geriatrics Society. 2008;56(10):1831-8.
van den Berg P. Zoledronate, fractures, and mortality after hip fracture. The New England journal of medicine. 2008;358(9):967.
Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2009;20(10):1633-50.
Phy MP, Vanness DJ, Melton LJ, 3rd, Long KH, Schleck CD, Larson DR, et al. Effects of a hospitalist model on elderly patients with hip fracture. Archives of internal medicine. 2005;165(7):796-801.
Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, et al. Meta-analysis: Excess Mortality After Hip Fracture Among Older Women and Men. Annals of internal medicine. 2010;152(6):380-90.
Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984(186):45-56.
Panula J, Pihlajamäki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P, et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC musculoskeletal disorders. 2011;12:105.
Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clinical orthopaedics and related research. 1984(186):45-56.
Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. JBJS. 1995;77(10):1551-6.
Suh YS, Kim YB, Choi HS, Yoon HK, Seo GW, Lee BI. Postoperative Mortality and the Associated Factors in Elderly Patients with Hip Fracture. J Korean Orthop Assoc. 2012;47(6):445-51.
Tell GS, Lunde A, Apalset EM, Pedersen AB, Sørensen HT, Ehrenstein V, et al. The Role of Comorbidity in Mortality After Hip Fracture: A Nationwide Norwegian Study of 38,126 Women With Hip Fracture Matched to a General-Population Comparison Cohort. American Journal of Epidemiology. 2018;188(2):398-407.
Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ (Clinical research ed). 2005;331(7529):1374.
Gulcelik NE, Bayraktar M, Caglar O, Alpaslan M, Karakaya J. Mortality after hip fracture in diabetic patients. Experimental and clinical endocrinology & diabetes: German Society of Endocrinology [and] German Diabetes Association. 2011;119(7):414-8.
Puar TH, Khoo JJ, Cho LW, Xu Y, Chen YT, Chuo AM, et al. Association between glycemic control and hip fracture. Journal of the American Geriatrics Society. 2012;60(8):1493-7.
Karaeminogullari O, Demirors H, Sahin O, Ozalay M, Ozdemir N, Tandogan RN. Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis. The Journal of bone and joint surgery American volume. 2007;89(2):324-31.
Sunday JM, Guille JT, Torg JS. Complications of joint arthroplasty in patients with end-stage renal disease on hemodialysis. Clin Orthop Relat Res. 2002(397):350-5.
Sakalkale DP, Hozack WJ, Rothman RH. Total hip arthroplasty in patients on long-term renal dialysis. J Arthroplasty. 1999;14(5):571-5.
Vochteloo AJH, Borger van der Burg BLS, Mertens BJA, Niggebrugge AHP, de Vries MR, Tuinebreijer WE et al. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients. BMC musculoskeletal disorders. 2011;12:262.