Factors associated with one-year mortality rate after hip fracture in osteoporosis patients

Authors

  • Tonanakan Khunhon Orthopedic Chaiyaphum Hospital

Keywords:

Hip Fracture, Osteoporosis, Mortality, Risk Factors

Abstract

Objective: To study one-year mortality rate and associated factors in patients with osteoporotic hip fracture.

Materials and Methods: This five-year retrospective study in Chaiyaphum Hospital. A total of 754 Thai patients who had been admitted with hip fractures resulting from simple falls were identified using the International Classification of Disease 10 codes, Data were collected from medical records and vital status from Thai Registering System, Registration Office, Department of Provincial Administration, Ministry of Interior. Data were analyzed by frequency, percentage, mean, standard deviation, Chi-squared test, univariable analysis and multivariable analysis by risk ratio regression. Statistical significant was at p<0.05

Results: Mortality rate of hip fracture patients was 13.12%. prognostic factors found to be significantly associated with mortality were pulmonary embolism (RR=5.32, p<0.001), non-ambulatory patient (RR=3.97, p<0.001), pneumoniae (RR=3.63, p<0.001), cardiovascular disease (RR=1.74, p<0.001), Charlson comorbidity index (CCI) >5 point (RR=1.59, p=0.003), urinary tract infection (RR=1.57, p<0.0001), non-surgical treatment (RR=1.46, p<0.001), and time to surgery more than 72 hour (RR=1.30, p=0.009)

Conclusion: Pulmonary embolism, non-ambulation patient, pneumoniae, cardiovascular disease, CCI >5 point, urinary tract infection, non-surgical treatment, and time to surgery more than 72 hour were associated with mortality in patients with hip fractures. The risks of mortality were 5.32, 3.97, 3.63, 1.74, 1.59, 1.57, 1.46 and 1.30 times higher than patients without those factors.

References

สำนักงานสภาพัฒนาการเศรษฐกิจและสังคมแห่งชาติ. รายงานการศึกษาข้อสมมุติเพื่อใช้ในการ คาดประมาณประชากรของประเทศไทย พ.ศ.2553-2583 (ฉบับปรับปรุง). กรุงเทพฯ: บริษัท อมรินทร์พริ้นติ้งแอนด์พับลิชชิ่ง จากัด (มหาชน), 2562.

Chariyalertsak S, Suriyawongpisal P, Thakkinstain A. Mortality after hip fractures in Thailand. Int Orthop, 2001;25(5):294-7.

Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg, 2019;14(1):203.

Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Mortality Risk After Hip Fracture. J Orthop Trauma, 2003;17(1):53-6.

González-Marcos E, González-García E, Rodríguez-Fernández P, Sánchez-González E, González-Bernal JJ, González-Santos J. Determinants of Higher Mortality at Six Months in Patients with Hip Fracture: A Retrospective Study. J Clin Med, 2022;11(9):2514.

Li S, Sun T, Liu Z. Excess mortality of 1 year in elderly hip fracture patients compared with the general population in Beijing, China. Arch Osteoporos, 2016;11(1):35.

Sofu H, Üçpunar H, Çamurcu Y, Duman S, Konya MN, Gürsu S, et al. Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture. Ulus Travma Ve Acil Cerrahi Derg Turk J Trauma Emerg Surg TJTES, 2017;23(3):245-50.

Nijmeijer WS, Folbert EC, Vermeer M, Slaets JP, Hegeman JH. Prediction of early mortality following hip fracture surgery in frail elderly: The Almelo Hip Fracture Score (AHFS). Injury, 2016;47(10):2138-43.

Peterle VCU, Novaes MRCG, Junior PEB, Júnior JCG, Magalhães Cavalcante RT, da Silva Junior JB, et al. Osteoporotic hip fracture-Comorbidities and factors associated with in-hospital mortality in the elderly: A nine-year cohort study in Brazil. PloS One, 2022;17(8):e0272006.

Folbert EC, Hegeman JH, Vermeer M, Regtuijt EM, van der Velde D, Ten Duis HJ, et al. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA, 2017;28(1):269-77.

Öztürk B, Johnsen SP, Röck ND, Pedersen L, Pedersen AB. Impact of comorbidity on the association between surgery delay and mortality in hip fracture patients: A Danish nationwide cohort study. Injury, 2019;50(2):424-31.

van de Ree CLP, De Jongh MAC, Peeters CMM, de Munter L, Roukema JA, Gosens T. Hip Fractures in Elderly People: Surgery or No Surgery? A Systematic Review and Meta-Analysis. Geriatr Orthop Surg Rehabil, 2017;8(3):173-80.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987;40(5):373-83.

Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol, 1994;47(11):1245-51.

Souza RC de, Pinheiro RS, Coeli CM, Camargo KR de. The Charlson comorbidity index (CCI) for adjustment of hip fracture mortality in the elderly: analysis of the importance of recording secondary diagnoses. Cad Saude Publica, 2008;24(2):315-22.

Jianda X, Homma Y, Jinnai Y, Baba T, Zhuang X, Watari T, et al. Relationship between Charlson comorbidity index, early recovery and 2-year mortality in elderly patients undergoing surgical treatment of inter-trochanteric fractures: a retrospective analysis. Sci Rep, 2021;11:17195.

Xing F, Luo R, Chen W, Zhou X. The risk-adjusted Charlson comorbidity index as a new predictor of one-year mortality rate in elderly Chinese patients who underwent hip fracture surgery. Orthop Traumatol Surg Res OTSR, 2021;107(3):102860.

Varady NH, Gillinov SM, Yeung CM, Rudisill SS, Chen AF. The Charlson and Elixhauser Scores Outperform the American Society of Anesthesiologists Score in Assessing 1-year Mortality Risk After Hip Fracture Surgery. Clin Orthop, 2021;479(9):1970-9.

De Luca A, Murena L, Zanetti M, De Colle P, Ratti C, Canton G. Should the early surgery threshold be moved to 72 h in over-85 patients with hip fracture? A single-center retrospective evaluation on 941 patients. Arch Orthop Trauma Surg, 2022.

Neuman MD, Archan S, Karlawish JH, Schwartz JS, Fleisher LA. The relationship between short-term mortality and quality of care for hip fracture: a meta-analysis of clinical pathways for hip fracture. J Am Geriatr Soc, 2009;57(11):2046-54.

Loggers SAI, Van Lieshout EMM, Joosse P, Verhofstad MHJ, Willems HC. Prognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis. Injury, 2020;51(11):2407-13.

Pablos-Hernández C, González-Ramírez A, da Casa C, Luis MM, García-Iglesias MA, Julián-Enriquez JM, et al. Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models. Orthop Surg, 2020;12(2):457-62.

Beaupre LA, Khong H, Smith C, Kang S, Evens L, Jaiswal PK, et al. The impact of time to surgery after hip fracture on mortality at 30- and 90-days: Does a single benchmark apply to all? Injury, 2019;50(4):950-5.

Atthakomol P, Manosroi W, Phinyo P, Pipanmekaporn T, Vaseenon T, Rojanasthien S. Prognostic Factors for All-Cause Mortality in Thai Patients with Fragility Fracture of Hip: Comorbidities and Laboratory Evaluations. Med Kaunas Lith, 2020;56(6):E311.

Magny E, Vallet H, Cohen-Bittan J, Raux M, Meziere A, Verny M, et al. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway. Arch Osteoporos, 2017;12(1):77.

Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, et al. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients. Arch Phys Med Rehabil, 2010;91(1):51-7.

Fukui N, Watanabe Y, Nakano T, Sawaguchi T, Matsushita T. Predictors for ambulatory ability and the change in ADL after hip fracture in patients with different levels of mobility before injury: a 1-year prospective cohort study. J Orthop Trauma, 2012;26(3):163-71.

Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, et al. Prediction of postoperative ambulatory status 1 year after hip fracture surgery. Arch Phys Med Rehabil, 2010;91(1):67-72.

Adulkasem N, Phinyo P, Khorana J, Pruksakorn D, Apivatthakakul T. Prognostic Factors of 1-Year Postoperative Functional Outcomes of Older Patients with Intertrochanteric Fractures in Thailand: A Retrospective Cohort Study. Int J Environ Res Public Health, 2021;18(13):6896.

Published

2022-12-30 — Updated on 2022-12-30

Versions

Issue

Section

Original Article