High mortality rate following periprosthetic femoral fractures after total hip arthroplasty. A multicenter retrospective study.

BACKGROUND: The main objective of this study was to evaluate the morbidity and mortality following periprosthetic femoral fractures (PFFs) after total hip arthroplasty. The secondary objectives were to explore risk factors for mortality and compare outcomes by method of treatment. METHODS: A multicenter retrospective study was conducted (2016-2017) of all PFFs after total hip arthroplasty. We collected data on: ASA score, Charlson comorbidity index, type of fracture, method of treatment, timing of surgery, length of stay, systemic and local complications and mortality. Functional outcome was assessed in terms of preoperative and postoperative ambulatory status. Univariate and multivariate analysis were performed in the sample to identify risk factors for mortality. RESULTS: A total of 107 patients were evaluated and their mean age was 81 years old. The most common type of fracture according to the Vancouver classification was B1 (52.4% of patients), followed by B2 fractures (31.8%). The mortality rate during the first month was 9.3% and was associated with patients with ASA >3. Mortality rate in the first year was 22.3% and was associated with poorer walking ability before surgery and Charlson index ≥3. In the multivariable analysis, Charlson index ≥3 (odds ratio = 6.85) and age ≥80 years old (odds ratio=7.446) were associated with 1-year mortality. Neither complications nor mortality rate were associated with either time to surgery or method of treatment. More than half of the patients (57.9%) did not regain their prefracture walking status. Major systemic complications developed in 23.4% of the patients and major local complications in 12.1%. CONCLUSION: Despite modern surgical techniques and multidisciplinary management, this study highlights the ambulatory status impairment and high rate of complications and mortality after PFF. Although the mortality rate during the first year was similar to that observed in other studies on PFFs, we found a higher mortality rate within the first month.

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study.

We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. PURPOSE: To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. METHODS: Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. RESULTS: A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. CONCLUSIONS: Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis.

[Cost and mortality associated to the surgical delay of patients with a hip fracture. Spain]. / Mortalidad y costes asociados a la demora del tratamiento quirúrgico por fractura de cadera.

BACKGROUND: Hip fractures surgery is often delayed for several days. The present work has two objectives. The first one is to determine the preoperative hospital length of stay of patients with a hip fracture in our region and its possible correlation with an increase in mortality rate. Secondly we assessed the healthcare expenditure associated to this preoperative period. METHODS: We carried out an observational, retrospective study in which all hip fractures attended in the Basque Country throughout 2010 were assessed by the Minimun Basic Data Set (MSBD): hospital, age, sex, preoperative hospital length, status at hospital discharge, comorbidities and surgical procedure. Furthermore we studied the Charlson Index and the total cost associated stratified by pre and post-operative period using a multiple model regression. RESULTS: A total of 1856 surgical procedures were analyzed. Average pre and post-operative length of stay was 2.7 and 9.7 days respectively. The mean total cost per hospital admission was 12,552 € with 1,295.5 € € corresponding to the preoperative period. The duration of preoperative stay is not associated with a significant reduction in mortality, although it did with an increase in the total cost. CONCLUSIONS: Preoperative hospital stay in patients with hip fracture is still challenging. We could not find an association between the delays in surgical procedures and hospital mortality, although it seems to be associated with an increased the total procedure cost. These results can serve as a foundation for setting up strategies to decrease the length of hospital stay, not only for cost-saving purposes.