Online citations, reference lists, and bibliographies.
← Back to Search

Effect Of Comorbidities And Postoperative Complications On Mortality After Hip Fracture In Elderly People: Prospective Observational Cohort Study

J. W. Roche, R. Wenn, O. Sahota, C. G. Moran
Published 2005 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Abstract Objectives To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality. Design Prospective observational cohort study. Setting University teaching hospital. Participants 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged < 60; those with periprosthetic fractures, pathological fractures, and fractures treated without surgery; and patients who died before surgery. Interventions Routine care for hip fractures. Main outcome measures Postoperative complications and mortality at 30 days and one year. Results Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart failure mortality was 65% at 30 days (hazard ratio 16.1, 95% confidence interval 12.2 to 21.3). Of these patients, 92% were dead by one year (11.3, 9.1 to 14.0). In patients who developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3). Conclusions In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.
This paper references
Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia.
P. Juelsgaard (1998)
Perioperative fluid optimization following proximal femoral fracture
JD Price (1998)
Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy
C. Hogue (1998)
Orthopaedic geriatric care--is it effective? A prospective population-based comparison of outcome in fractured neck of femur.
V. Hempsall (1990)
Survival after Hip Fracture: Short- and Long-Term Excess Mortality According to Age and Gender
L. Forsén (1999)
Time trends and demography of mortality after fractured neck of femur in an English population, 1968–98: database study
S. Roberts (2003)
Relationship between postoperative anemia and cardiac morbidity in high‐risk vascular patients in the intensive care unit
A. Nelson (1993)
A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients.
O. Boyd (1993)
Perioperative blood transfusion and postoperative mortality.
J. Carson (1998)
Standardised audit of hip fractures in Europe
P. Stride (2002)
Predictors of mortality after acute hip fracture
M. Nettleman (2007)
Perioperative fluid volume optimization following proximal femoral fracture.
J. Price (2002)
Royal College of Physicians. Osteoporosis. Clinical guidelines for prevention and treatment. London: Royal College of Physicians of London
Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications.
J. Kenzora (1984)
Combined orthogeriatric care in the management of hip fractures: a prospective study.
R. Khan (2002)
British Orthopaedic Association. The care of fragility fracture patients. London: British Orthopaedic Association
Scottish Intercollegiate Guidelines Network Prevention and Management of Hip Fracture in Older People
Cardiac predictors of death after non-cardiac surgery evaluated by intention to treat.
A. Dirksen (1988)
Mortality and morbidity after hip fractures.
G. Keene (1993)
15 Fractured neck of femur. Prevention and management. Summary and recommendations of a report of the Royal College of Physicians
Risk factors influencing mortality after bipolar hemiarthro - plasty in the treatment of fracture of the femoral neck
S Eiskjaer (1997)
Hospital Episode Statistics
Northgate (2006)
Hip fracture mortality.
Je Kenzora (1984)
Early mortality after hip fracture: is delay before surgery important?
C. Moran (2005)
Department of Health. Hospital episode statistics
Prevention and management. Summary and recommendations of a report of the Royal College of Physicians
An assessment of postoperative oxygen therapy in patients with fractured neck of femur.
A. Dyson (1988)
Risk factors influencing mortality after bipolar hemiarthroplasty in the treatment of fracture of the femoral neck.
S. Eiskjaer (1991)
Differences in mortality after fracture of hip: the East Anglian audit
C. Todd (1995)
Prevention and management of hip fracture in older people. Edinburgh: Scottish Intercollegiate Guidelines Network, 2002. 17 British Orthopaedic Association. The care of fragility fracture patients

This paper is referenced by
Time to death in a prospective cohort of 252 patients treated for fracture of the proximal femur in a major hospital in Portugal.
S. Campos (2015)
Do surgical trainees believe they are adequately trained to manage the ageing population? A UK survey of knowledge and beliefs in surgical trainees.
D. Shipway (2015)
An Examination of Family Caregiver Experiences during Care Transitions of Older Adults
Justine L. Giosa (2014)
Which Patients Are at Risk for Kidney Dysfunction After Hip Fracture Surgery?
G. Macheras (2013)
Internal Fixation Versus Hemiarthroplasty for Displaced Intra-Capsular Femoral Neck Fractures in ASA 3-5 Geriatric Patients
W. Rezaie (2016)
Cardiovascular biomarkers and risk of low-energy fractures among middle-aged men and women—A population-based study
Maria Härstedt (2018)
Risk factors for mortality and survival rates in elderly patients undergoing hemiarthroplasty for hip fracture.
A. Aslan (2020)
Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival.
P. Kannegaard (2010)
Relative interaction of material and structure in normal and pathologic bone
Ara Nazarian (2008)
Improving the quality of care for hip fracture patients : studies on fast-track to surgery and adverse events
Paula Kelly-Pettersson (2018)
Assessment of the impact of comorbidities on perioperative complications in pediatric neurosurgery.
A. Patel (2014)
Patients with isolated hip fracture must be considered for surgery irrespectively of their age, comorbidity status and provenance: a statement applicable even to nonagerians
E. Bergeron (2009)
Skeletal complications of ADT: disease burden and treatment options.
J. Planas Morin (2012)
Prognostic Value of Serum Procalcitonin After Orthopedic Surgery in the Elderly Population
H. Vallet (2017)
Inequality in 30-day mortality and the wait for surgery after hip fracture: the impact of the regional health care evaluation program in Lazio (Italy).
P. Colais (2013)
THU0377 Evaluation of Coronary Lesions Among Males with Coronary Heart Disease and Osteoporosis
E. Malyuta (2013)
Chronic kidney disease can increase the risk of preoperative deep vein thrombosis in middle-aged and elderly patients with hip fractures
Z. Wang (2018)
Anaesthesia for fractured neck of femur
Stanley Wong (2012)
Analgesia for spinal anesthesia positioning in elderly patients with proximal femoral fractures
Ki Hwa Lee (2020)
Controlling Bivariate Categorical Processes using Scan Rules
S. Bersimis (2017)
Elevated Neopterin Levels Predict Early Death in Older Hip-fracture Patients
Martin Larsen (2017)
Early orthogeriatric treatment of trauma in the elderly: a systematic review and metaanalysis.
B. Buecking (2013)
Predictors of Treatment Outcomes in Geriatric Patients With Odontoid Fractures
M. Fehlings (2013)
Rehabilitation Therapy After Surgery in Osteoporotic Patients
F. Gimigliano (2018)
Gender and Race/Ethnicity Differences in Hip Fracture Incidence, Morbidity, Mortality, and Function
R. Sterling (2011)
Prediction of Mortality and Postoperative Complications using the Hip-Multidimensional Frailty Score in Elderly Patients with Hip Fracture
J. Choi (2017)
W. Ekström (2008)
Cemented hemiarthroplasty after a femoral neck fracture. Survivorship analysis
M. Á. Ruiz-Ibán (2008)
Risk-adjusted mortality rates of elderly veterans with hip fractures.
E. Bass (2007)
Outcomes following fractured neck of femur in an Australian metropolitan teaching hospital
P. H. Chia (2013)
Early Surgery Confers 1-Year Mortality Benefit in Hip-Fracture Patients
K. Maheshwari (2018)
Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study
Po-Hsun Lin (2020)
See more
Semantic Scholar Logo Some data provided by SemanticScholar