Risk prediction models of mortality after hip fracture surgery in older individuals: a systematic review.

OBJECTIVE: This study aimed to critically assess existing risk prediction models for postoperative mortality in older individuals with hip fractures, with the objective of offering substantive insights for their clinical application. DESIGN: A comprehensive search was conducted across prominent databases, including PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP, and Wanfang, spanning original articles in both Chinese and English up until 1 December 2023. Two researchers independently extracted pertinent research characteristics, such as predictors, model performance metrics, and modeling methodologies. Additionally, the bias risk and applicability of the incorporated risk prediction models were systematically evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS: Within the purview of this investigation, a total of 21 studies were identified, constituting 21 original risk prediction models. The discriminatory capacity of the included risk prediction models, as denoted by the minimum and maximum areas under the subject operating characteristic curve, ranged from 0.710 to 0.964. Noteworthy predictors, recurrent across various models, included age, sex, comorbidities, and nutritional status. However, among the models assessed through the PROBAST framework, only one was deemed to exhibit a low risk of bias. Beyond this assessment, the principal limitations observed in risk prediction models pertain to deficiencies in data analysis, encompassing insufficient sample size and suboptimal handling of missing data. CONCLUSION: Subsequent research endeavors should adopt more stringent experimental designs and employ advanced statistical methodologies in the construction of risk prediction models. Moreover, large-scale external validation studies are warranted to rigorously assess the generalizability and clinical utility of existing models, thereby enhancing their relevance as valuable clinical references.

CRP/albumin ratio in predicting 1-year mortality in elderly patients undergoing hip fracture surgery.

OBJECTIVE: In the literature, rates of up to 37.1% have been reported for 1-year mortality after hip fractures. In this study, we aimed to determine whether the C-reactive protein/albumin ratio (CAR) is an independent risk factor for 1-year mortality after hip fracture and whether CAR, neutrophil/lymphocyte ratio (NLR), CRP, albumin level, and other parameters have an effect on mortality and morbidity. PATIENTS AND METHODS: Over a 3-year period, 480 patients aged 65 years and older who underwent hemiarthroplasty for hip fracture were analyzed. A univariate logistic regression analysis was performed to identify prognostic factors for 1-year mortality. Significant variables were re-evaluated using binary logistic regression analysis. RESULTS: The number of patients who died within 1 year postoperatively was 95 (27.7%), and the median age was 85 years. In the receiver operating characteristic analysis (ROC) for 1-year mortality after hip fracture, the optimal cut-off value of CAR was found to be 1.03. The area under the curve (AUC) for mortality was 0.843, the sensitivity was 65.3%, and the specificity was 92.7% [95% confidence interval (CI), 0.791-0.895; p < 0.001]. The optimal cut-off value for CRP was 2.85, the AUC was 0.838, the sensitivity was 70%, and the specificity was 89% (95% CI, 0.785-0.890; p < 0.001). The optimal cut-off value of NLR for postoperative intensive care unit (ICU) admission was determined to be 6.64. CONCLUSIONS: CAR was a predictive factor for 1-year postoperative mortality and postoperative ICU admission, whereas NLR was a predictive factor for postoperative ICU admission.

Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz / Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

Excess mortality in elderly hip fracture patients: An Indian experience.

PURPOSE: Hip fractures in elderly have a high mortality. However, there is limited literature on the excess mortality seen in hip fractures compared to the normal population. The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population. METHODS: There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study. Patients were followed up for 1 year and the follow-up record was available for 279 patients. Mortality was assessed during the follow-up from chart review and/or by telephonic interview. One-year mortality of Indian population was obtained from public databases. Standardized mortality ratio (SMR) (observed mortality divided by expected mortality) was calculated. Kaplan-Meir analysis was used. RESULTS: The overall 1-year mortality was 19.0% (53/279). Mortality increased with age (p < 0.001) and the highest mortality was seen in those above 80 years (aged 50 - 59 years: 5.0%, aged 60 - 69 years: 19.7%, aged 70 - 79 years: 15.8%, and aged over 80 years: 33.3%). Expected mortality of Indian population of similar age and gender profile was 3.7%, giving a SMR of 5.5. SMR for different age quintiles were: 3.9 (aged 50 - 59 years), 6.6 (aged 60 - 69 years), 2.2 (aged 70 - 79 years); and 2.0 (aged over 80 years). SMR in males and females were 5.7 and 5.3, respectively. CONCLUSIONS: Indian patients sustaining hip fractures were about 5 times more likely to die than the general population. Although mortality rates increased with age, the highest excess mortality was seen in relatively younger patients. Hip fracture mortality was even higher than that of myocardial infarction, breast cancer, and cervical cancer.

Mortality following fragility hip fracture in China: a record linkage study.

Mortality risk declined over time. Patients with fragility hip fracture experienced an approximate ninefold excess mortality, peaking shortly after fracture, in comparison with that of the general population. Continuous efforts in lowering the occurrence of hip fracture have the potential to improve the survival of the elderly population in China. PURPOSE: Hip fractures in older adults often lead to an elevated risk of death. However, few studies investigated mortality risk following hip fracture in mainland China. This retrospective cohort study aimed to evaluate the crude mortality and excess mortality after fragility hip fractures in Lishui residents aged 50 years and older. METHODS: Patients having a fragility hip fracture between October 2013 and August 2019 were identified from the Lishui District Inpatient Data Collection and followed up until August 2020. Death information was ascertained from the linked death registry records. We calculated the follow-up mortality rate and corresponding 95% confidence intervals (CIs) as well as the standard mortality ratios (SMRs) in comparison with the mortality rates of Lishui residents. RESULTS: During the study period, a total of 808 patients (63.4% females) with an average age of 75 years were admitted for fragility hip fractures. The 1st, 2nd, and 3rd year follow-up mortality rates were 16.51, 6.06, and 5.03 per 100 person-year, respectively. The SMRs were 8.46 (6.94, 9.97), 5.74 (4.86, 6.63), and 4.63 (3.98, 5.27) for the 1st, 2nd, and 3rd year following fragility hip fracture. CONCLUSION: Although mortality risk declined over time, patients with fragility hip fracture experienced an approximate ninefold excess mortality, peaking shortly after fracture, in comparison with that of the general population. Continuous efforts in lowering the occurrence of hip fracture have the potential to improve the survival of the elderly population in China.

The modified lymphocyte C-reactive protein score is a promising indicator for predicting 3-year mortality in elderly patients with intertrochanteric fractures.

BACKGROUND: Hip fractures are common in elderly patients, and almost all the patients undergo surgery. This study aimed to develop a novel modified lymphocyte C-reactive protein (CRP) score (mLCS) to simply and conveniently predict 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery. METHODS: A retrospective study was conducted on elderly patients who underwent intertrochanteric fracture surgery between January 2014 and December 2017. The mLCS was developed according to the value of CRP and lymphocyte counts. Univariate and multivariate Cox regression analyses were used to identify independent risk factors for 3-year mortality after surgery. The performances of the lymphocyte CRP score (LCS) and mLCS to predict 3-year mortality were then compared using C-statistics, decision curve analysis (DCA), net reclassification index (NRI) and integrated discrimination improvement (IDI). RESULTS: A total of 291 patients were enrolled, of whom 52 (17.9%) died within 3 years after surgery. In the multivariate Cox regression analysis, mLCS (hazard ratio (HR), 5.415; 95% confidence interval (CI), 1.743-16.822; P = 0.003) was significantly associated with postoperative 3-year mortality. The C-statistics of LCS and mLCS for predicting 3-year mortality were 0.644 and 0.686, respectively. The NRI (mLCS vs. LCS, 0.018) and IDI (mLCS vs. LCS, 0.017) indicated that the mLCS performed better than the LCS. DCA also showed that mLCS had a higher clinical net benefit. CONCLUSIONS: mLCS is a promising predictor that can simply and conveniently predict 3-year mortality in elderly patients undergoing intertrochanteric fracture surgery.

Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture.

BACKGROUND: Clinical guidelines recommend low-molecular-weight heparin for thromboprophylaxis in patients with fractures, but trials of its effectiveness as compared with aspirin are lacking. METHODS: In this pragmatic, multicenter, randomized, noninferiority trial, we enrolled patients 18 years of age or older who had a fracture of an extremity (anywhere from hip to midfoot or shoulder to wrist) that had been treated operatively or who had any pelvic or acetabular fracture. Patients were randomly assigned to receive low-molecular-weight heparin (enoxaparin) at a dose of 30 mg twice daily or aspirin at a dose of 81 mg twice daily while they were in the hospital. After hospital discharge, the patients continued to receive thromboprophylaxis according to the clinical protocols of each hospital. The primary outcome was death from any cause at 90 days. Secondary outcomes were nonfatal pulmonary embolism, deep-vein thrombosis, and bleeding complications. RESULTS: A total of 12,211 patients were randomly assigned to receive aspirin (6101 patients) or low-molecular-weight heparin (6110 patients). Patients had a mean (±SD) age of 44.6±17.8 years, 0.7% had a history of venous thromboembolism, and 2.5% had a history of cancer. Patients received a mean of 8.8±10.6 in-hospital thromboprophylaxis doses and were prescribed a median 21-day supply of thromboprophylaxis at discharge. Death occurred in 47 patients (0.78%) in the aspirin group and in 45 patients (0.73%) in the low-molecular-weight-heparin group (difference, 0.05 percentage points; 96.2% confidence interval, -0.27 to 0.38; P<0.001 for a noninferiority margin of 0.75 percentage points). Deep-vein thrombosis occurred in 2.51% of patients in the aspirin group and 1.71% in the low-molecular-weight-heparin group (difference, 0.80 percentage points; 95% CI, 0.28 to 1.31). The incidence of pulmonary embolism (1.49% in each group), bleeding complications, and other serious adverse events were similar in the two groups. CONCLUSIONS: In patients with extremity fractures that had been treated operatively or with any pelvic or acetabular fracture, thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin in preventing death and was associated with low incidences of deep-vein thrombosis and pulmonary embolism and low 90-day mortality. (Funded by the Patient-Centered Outcomes Research Institute; PREVENT CLOT ClinicalTrials.gov number, NCT02984384.).

Fractura de cadera en pacientes centenarios, ¿qué podemos esperar? / Hip fracture in centenarians, what can we expect?

Introducción: La mejoría de la esperanza de vida está incrementando la incidencia de fractura de cadera en centenarios. Nuestro objetivo es comparar las características basales de una serie de centenarios con fractura de cadera frente a controles de menor edad, analizando si existen diferencias en cuanto a complicaciones, mortalidad intrahospitalaria y supervivencia a corto-medio plazo. Material y métodos: Estudio retrospectivo, tipo caso control, sobre 24 centenarios y 48 controles octogenarios con fractura de cadera. Se analizó la presencia de comorbilidades y el índice de Charlson, la demora quirúrgica, las complicaciones, la estancia hospitalaria y la mortalidad durante el ingreso. Al alta se valoró la mortalidad precoz, la supervivencia después del año y el retorno a la funcionalidad previa. Resultados: No se encontraron diferencias significativas en parámetros basales ni en comorbilidades (p>0,05), siendo el paciente tipo una mujer con fractura extracapsular. La estancia hospitalaria fue mayor en el grupo control (p=0,038) y la complicación más frecuente la anemia, que precisó transfusión sanguínea (23/24 en los centenarios, p<0,0001). La mortalidad intrahospitalaria y acumulada al año en los centenarios fue del 33 y el 67%, respectivamente, frente al 10 y 25% en octogenarios (p=0,017, OR=4,3 [1,224-15,101] y p=0,110]. Solo 2 pacientes centenarios consiguieron volver a caminar tras la intervención, frente a un 53,84% que volvió a la situación funcional previa en los controles (p=0,003). Conclusiones: Frente a un grupo control de pacientes de menor edad, la mortalidad intrahospitalaria y en el primer año tras una fractura de cadera es significativamente mayor en los centenarios y muy pocos recuperan la actividad previa a la fractura.(AU)

Introduction: Hip fractures in centenarians are rising due to the increase in life expectancy. The objective of this study is to compare the characteristics of centenarians’ hip fracture with a younger control group, and to analyze whether there are differences in terms of in-hospital mortality, complications, and short-medium-term survival between them. Material and methods: Retrospective case-control study, with a series of 24 centenarians and 48 octogenarians with a hip fracture. Comorbidities and Charlson index, surgical delay, complications and mortality during admission, and hospital stay were analyzed. At discharge, early mortality, survival after one year, and return to previous functionality were assessed. Results: No significant differences were found in baseline parameters or comorbidities (P>.05), and the type of was a woman with an extracapsular fracture. Hospital stay was longer in the control group (P=.038), and the most frequent complication was anemia requiring transfusion (23/24 in centenarians, P<.0001). In-hospital mortality and accumulated at one year in the centenarians was 33 and 67%, respectively, compared to 10 and 25% in the octogenarians (P=.017, OR=4.3 [1,224-15,101] and P=.110). Only 2 centenarian patients were able to walk again after the intervention, while in the control group 53.84% returned to the previous functional situation (P=.003). Conclusions: Compared to a control group of younger patients, in-hospital mortality and in the first year after a hip fracture is significantly higher in centenarians, and very few recover activity prior to the fracture.(AU)

Hip fracture in centenarians, what can we expect? / Fractura de cadera en pacientes centenarios. ¿Qué podemos esperar?

Introduction: Hip fractures in centenarians are rising due to the increase in life expectancy. The objective of this study is to compare the characteristics of centenarians’ hip fracture with a younger control group, and to analyze whether there are differences in terms of in-hospital mortality, complications, and short-medium-term survival between them. Material and methods: Retrospective case-control study, with a series of 24 centenarians and 48 octogenarians with a hip fracture. Comorbidities and Charlson index, surgical delay, complications and mortality during admission, and hospital stay were analyzed. At discharge, early mortality, survival after one year, and return to previous functionality were assessed. Results: No significant differences were found in baseline parameters or comorbidities (P>.05), and the type of was a woman with an extracapsular fracture. Hospital stay was longer in the control group (P=.038), and the most frequent complication was anemia requiring transfusion (23/24 in centenarians, P<.0001). In-hospital mortality and accumulated at one year in the centenarians was 33 and 67%, respectively, compared to 10 and 25% in the octogenarians (P=.017, OR=4.3 [1,224-15,101] and P=.110). Only 2 centenarian patients were able to walk again after the intervention, while in the control group 53.84% returned to the previous functional situation (P=.003). Conclusions: Compared to a control group of younger patients, in-hospital mortality and in the first year after a hip fracture is significantly higher in centenarians, and very few recover activity prior to the fracture.(AU)

Introducción: La mejoría de la esperanza de vida está incrementando la incidencia de fractura de cadera en centenarios. Nuestro objetivo es comparar las características basales de una serie de centenarios con fractura de cadera frente a controles de menor edad, analizando si existen diferencias en cuanto a complicaciones, mortalidad intrahospitalaria y supervivencia a corto-medio plazo. Material y métodos: Estudio retrospectivo, tipo caso control, sobre 24 centenarios y 48 controles octogenarios con fractura de cadera. Se analizó la presencia de comorbilidades y el índice de Charlson, la demora quirúrgica, las complicaciones, la estancia hospitalaria y la mortalidad durante el ingreso. Al alta se valoró la mortalidad precoz, la supervivencia después del año y el retorno a la funcionalidad previa. Resultados: No se encontraron diferencias significativas en parámetros basales ni en comorbilidades (p>0,05), siendo el paciente tipo una mujer con fractura extracapsular. La estancia hospitalaria fue mayor en el grupo control (p=0,038) y la complicación más frecuente la anemia, que precisó transfusión sanguínea (23/24 en los centenarios, p<0,0001). La mortalidad intrahospitalaria y acumulada al año en los centenarios fue del 33 y el 67%, respectivamente, frente al 10 y 25% en octogenarios (p=0,017, OR=4,3 [1,224-15,101] y p=0,110]. Solo 2 pacientes centenarios consiguieron volver a caminar tras la intervención, frente a un 53,84% que volvió a la situación funcional previa en los controles (p=0,003). Conclusiones: Frente a un grupo control de pacientes de menor edad, la mortalidad intrahospitalaria y en el primer año tras una fractura de cadera es significativamente mayor en los centenarios y muy pocos recuperan la actividad previa a la fractura.(AU)

Methyl-CpG binding protein 2 is associated with the prognosis and mortality of elderly patients with hip fractures.

OBJECTIVES: To investigate the expression level and clinical significance of Methyl-CpG binding Protein 2 (MECP2) in elderly patients with hip fractures. METHODS: This prospective observational study included 367 elderly patients with hip fractures between April 2016 and December 2018. All the patients were treated with internal fixation or joint replacement. In addition, 50 healthy elderly individuals were enrolled as healthy controls. The serum levels of MECP2 and inflammatory factors Interleukin (IL)-1ß, IL-6, IL-8, and Tumor Necrosis Factor (TNF)-α was determined by enzyme-linked immunosorbent assay. Data on patients' basic characteristics and postoperative complications were collected. The Harris score was used to assess hip function at 1-month, 3-months, and 6-months after surgery. Patient quality of life was measured using the Barthel Index (BI) score 3-months after surgery. The 1-year mortality was analyzed using the Kaplan-Meier curve, and logical regression was used to analyze the risk factors for mortality. RESULTS: No significant differences were observed in the basic clinical characteristics of all patients. The serum MECP2 levels were remarkably high in patients with hip fractures and negatively correlated with serum IL-1ß, IL-6, and TNF-α levels. Patients with higher MECP2 predicted higher dynamic Harris scores, lower postoperative complications, lower 1-year mortality, and higher BI scores. Logical regression showed that age was the only independent risk factor for postoperative 1-year mortality in elderly patients with hip fractures. CONCLUSION: Lower MECP2 predicted poor prognosis and higher 1-year mortality in elderly patients with hip fractures.

Análisis de los factores de riesgo de mortalidad al año en pacientes con fractura de cadera osteoporótica en España: un estudio observacional prospectivo / Analysis of risk factors for mortality at one year in patients with osteoporotic hip fracture in Spain: a prospective observational study

Objetivo: Analizar los factores de riesgo que inciden en la mortalidad al año de las fracturas de cadera osteoporóticas en España. Materiales y métodos: Fue un estudio observacional prospectivo. Los pacientes con fractura de cadera que fueron intervenidos quirúrgicamente en el Hospital Universitario Virgen Macarena de Sevilla, España del1 de enero de 2017 al 31 de diciembre de 2017. Se recopiló la información requerida a través de registros de historia clínica y seguimiento. Se realizó un análisis de factor único para descartar los factores con p<0,1, y luego estos factores se incluyeron en el análisis de regresión de Cox para averiguar los factores de riesgo independientes para la mortalidad posoperatoria al año. Resultados: Se incluyeron un total de 426 participantes, 107 hombres (25,1%) y 319 mujeres (74,9%). Durante el seguimiento de un año fallecieron 81 casos (19,0%). Hubo 7 factores de riesgo independientes relacionados con la tasa de mortalidad al año de las fracturas de cadera osteoporóticas en España: Los factores de riesgo inmodificables incluyeron los niveles de actividad previos a la lesión, ASA grado 4 y enfermedad pulmonar combina-da. Los factores de riesgo prevenibles incluyeron complicaciones respiratorias, complicaciones cardiovasculares, complicaciones cerebrovasculares, y trombosis venosa. Conclusión: La tasa de mortalidad de las fracturas de cadera osteoporóticas en España es relativamente alta, pero mediante la prevención activa de las complicaciones postoperatorias, la tasa de mortalidad puede disminuir. (AU)

Objetive: Aanalyze the risk factors that affect the one-year mortality of osteoporotic hip fractures in Spain. Materials and methods: This was a prospective observational study. Participants came from patients with hip fractures who underwent surgery at the Virgen Macarena University Hospital in Seville, Spain from January 1, 2017 to December 31, 2017. The required infor-mation was collected through medical history re-cords and follow-up. A single factor analysis was performed to screen out the factors with p<0.1, and then these factors were brought into the Cox regression analysis to find out the independent risk factors for the one-year postoperative mortality. Results: A total of 426 participants were included, 107 males (25.1%) and 319 females (74.9%). During the one-year follow-up, 81 cases (19.0%) died. There were 7 independent risk factors related to the one-year mortality rate of osteoporotic hip fractures in Spain: Unchangeable risk factors in-cluded pre-injury activity levels, ASA grade 4 , and combined lung disease. Preventable risk factors included respiratory complications, cardiovascu-lar complications cerebrovascular complications, and venous thrombosis. Conclusion: The mortality rate of osteoporotic hip frac-tures in Spain is relatively high, but through active prevention of postoperative complications, the mortality rate may decrease. (AU)

A comparative study of hip fracture care and outcomes in major trauma centres versus trauma units.

INTRODUCTION: There is good evidence to support that major trauma networks significantly reduce morbidity and mortality in severely injured patients. However, following the introduction of major trauma centres (MTCs) in England in 2012, early concerns were raised regarding the effect on hip fracture patients. The aim of our study was to review data from the National Hip Fracture Database for fractured neck of femur (FNOF) patients, comparing patient outcomes between MTCs and trauma units (TUs), and the national regions of the UK. METHODS: NHFD data from 2018 for all hospitals in England, Wales and NI was collected using the charts and dashboards available online. We recorded data for the following outcomes: time to surgery, acute hospital length of stay, overall hospital length of stay, discharge to original residence within 120 days, crude 30-day mortality and adjusted 30-day mortality. We conducted a one-way ANOVA test to calculate statistical differences for each outcome measure by MTC vs TU and then separately for the regions of the UK divided into England, Wales and Northern Ireland (NI). RESULTS: Data for 175 hospitals are included in this study; 22 of which were MTCs. The total number of operative cases were 65,848. 9668 of these occurred in MTC compared to 56,180 in TUs. This equates to an annual average of 439 per MTC and 367 per TU. Despite this, there was no statistically significant difference observed in all outcomes for MTC vs TU. Patients in NI waited longer for their surgery (60.3 h, p < 0.001), whilst patients in Wales had the longest overall hospital length of stay (31.6 days, p < 0.001). However, there was no difference in patients' crude 30-day mortality (p = 0.480) or adjusted 30-day mortality (p = 0.191). CONCLUSION: These findings are reassuring for MTCs in England. We found no evidence to suggest that FNOF patients are treated inferiorly, or have worse outcomes, at MTCs vs TUs. FNOF patients in NI waited longer for their surgery but this did not have any significant difference on 30-day mortality rates. The care of FNOF patients in NI may warrant further study.

Excess mortality after hip fracture during COVID-19 pandemic: More about disruption, less about virulence-Lesson from a trauma center.

To date, literature has depicted an increase in mortality among patients with hip fractures, directly related to acute coronavirus disease 2019 (COVID-19) infection and not due to underlying comorbidities. Usual orthogeriatric pathway in our Department was disrupted during the pandemic. This study aimed to evaluate early mortality within 30 days, in 2019 and 2020 in our Level 1 trauma-center. We compared two groups of patients aged >60 years, with osteoporotic upper hip fractures, in February/March/April 2020 and February/March/April 2019, in our level 1 trauma center. A total of 102 and 79 patients met the eligibility criteria in 2019 and 2020, respectively. Mortality was evaluated, merging our database with the French open database for death from the INSEE, which is prospectively updated each month. Causes of death were recorded. Charlson Comorbidity Index was evaluated for comorbidities, Instrumental Activity of Daily Living (IADL), and Activity of Daily Living (ADL) scores were assessed for autonomy. There were no differences in age, sex, fracture type, Charlson Comorbidity Index, IADL, and ADL. 19 patients developed COVID-19 infection. The 30-day survival was 97% (95% CI, 94%-100%) in 2019 and 86% (95% CI, 79%-94%) in 2020 (HR = 5, 95%CI, 1.4-18.2, p = 0.013). In multivariable Cox'PH model, the period (2019/2020) was significantly associated to the 30-day mortality (HR = 6.4, 95%CI, 1.7-23, p = 0.005) and 6-month mortality (HR = 3.4, 95%CI, 1.2-9.2, p = 0.01). COVID infection did not modify significantly the 30-day and 6-month mortality. This series brought new important information, early mortality significantly increased because of underlying disease decompensation. Minimal comprehensive care should be maintained in all circumstances in order to avoid excess of mortality among elderly population with hip fractures.

Treatment of intertrochanteric femur fracture with closed external fixation in high-risk geriatric patients: can it be the most reliable method that reduces mortality to minimum compared to proximal femoral nail and hemiarthroplasty?

ABSTRACT: The optimal surgical treatment of intertrochanteric femur fractures (ITF) to minimize the increased mortality in geriatric patients with high anesthetic risk was investigated by comparing closed external fixation (EF), a minimal invasive and biological osteosynthesis technique, proximal femoral nail (PFN) and hemiarthroplasty (HA) methods.Three different surgical methods were performed to 167 patients who were admitted to our clinic for ITF between 2014 and 2020 and considered at high risk (American Society of Anesthesiologists III - American Society of Anesthesiologists IV) by the Anesthesiology and Reanimation Department. Patients with multi-trauma, osteoarthritis, those with malignancies and developmental hip dysplasia were excluded from the study. Group I included patients who underwent closed reduction - external fixation (n = 46), Group II included patients who underwent partial arthroplasty (n = 77), and Group III included those who received PFN (n = 44). All fractures were classified according to the Modified Evans (Kyle) method and divided into 2 categories as type 1-2 (stable) and type 3-4 (unstable).The mean operation duration was 23 minutes and follow-up time was 14 months in Group 1, in which there was no in-hospital mortality. Five patients died due to non-operative reasons within 1 year. The mean operation duration and follow-up time in Group 2 were 40 minutes and 12 months, respectively. Six patients (7.8%) died during the operation or hospitalization, while 17 patients died due to comorbidities within 1 year. In Group 3, the mean operation duration and follow-up time were 40 minutes and 13 months, respectively. One patient died during the operation and 1 patient (n = 2, 4.5%), within 24 hours in the postoperative intensive care unit. Seven patients died due to comorbidities within 1 year. Statistical analysis revealed that the mean duration of operation, postoperative hospital stay, overall mortality and blood product transfusion amount were significantly lower in the EF group compared to other treatment methods.Closed EF is the most reliable surgical method that can minimize mortality in geriatric patients compared to other surgical options, due to the short duration of the operation, no evacuation of the fracture hematoma, early mobilization, lack of blood transfusion requirement, and early union.

Risk of mortality and reoperation in hip fracture patients undergoing cemented versus uncemented hemiarthroplasty : a population-based study from Danish National Registries.

AIMS: The aim of this study was to assess the association of mortality and reoperation when comparing cemented and uncemented hemiarthroplasty (HA) in hip fracture patients aged over 65 years. METHODS: This was a population-based cohort study on hip fracture patients using prospectively gathered data from several national registries in Denmark from 2004 to 2015 with up to five years follow-up. The primary outcome was mortality and the secondary outcome was reoperation. Hazard ratios (HRs) for mortality and subdistributional hazard ratios (sHRs) for reoperations are shown with 95% confidence intervals (CIs). RESULTS: A total of 17,671 patients with primary HA were identified (9,484 uncemented and 8,187 cemented HAs). Compared to uncemented HA, surgery with cemented HA was associated with an absolute risk difference of 0.4% for mortality within the period zero to one day after surgery and an adjusted HR of 1.70 (95% CI 1.22 to 2.38). After seven days, there was no longer any association, with an adjusted HR of 1.07 (95% CI 0.90 to 1.28). This continued until five years after surgery with a HR of 1.01 (95% CI 0.96 to 1.06). There was a higher proportion of reoperations due to any reason after five years in the uncemented group with 10.2% compared to the cemented group with 6.1%. This yielded an adjusted sHR of 0.65 (95% CI 0.57 to 0.75) and difference continued up until five years after the surgery, demonstrating a sHR of 0.70 (95% CI 0.59 to 0.83). CONCLUSION: In a non-selected cohort of hip fracture patients, surgery with cemented HA was associated with a higher relative mortality during the first postoperative day compared to surgery with uncemented HA, but there was no difference after seven days up until five years after. In contrast, surgery with cemented HA was associated with lower risk of reoperation up to five years postoperatively compared with surgery with uncemented HA. There was a higher relative mortality on the first postoperative day for cemented HA versus uncemented HA. There was no difference in mortality after seven days up until five years after surgery. There were 6.1% reoperations for cemented HA compared to 10.2% for uncemented HA after five years. Cite this article: Bone Joint J 2022;104-B(1):127-133.

The effect of intra-operative hypotension on acute kidney injury, postoperative mortality and length of stay following emergency hip fracture surgery.

The association between intra-operative hypotension and postoperative acute kidney injury, mortality and length of stay has not been comprehensively evaluated in a large single-centre hip fracture population. We analysed electronic anaesthesia records of 1063 patients undergoing unilateral hip fracture surgery, collected from 2015 to 2018. Acute kidney injury, 3-, 30- and 365-day mortality and length of stay were evaluated to assess the relationship between intra-operative hypotension absolute values (≤ 55, 60, 65, 70 and 75 mmHg) and duration of hypotension. The rate of acute kidney injury was 23.7%, mortality at 3-, 30- and 365 days was 3.7%, 8.0% and 25.3%, respectively, and median (IQR [range]) length of stay 8 (6-12 [0-99]) days. Median (IQR [range]) time ≤ MAP 55, 60, 65, 70 and 75 mmHg was 0 (0-0.5[0-72.1]); 0 (0-4.4 [0-104.9]); 2.2 (0-8.7 [0-144.2]); 6.6 (2.2-19.7 [0-198.8]); 17.5 (6.6-37.1 [0-216.3]) minutes, and percentage of surgery time below these thresholds was 1%, 2.5%, 7.9%, 12% and 21% respectively. There were some univariate associations between hypotension and mortality; however, these were no longer evident in multivariable analysis. Multivariable analysis found no association between hypotension and acute kidney injury. Acute kidney injury was associated with male sex, antihypertensive medications and cardiac/renal comorbidities. Three-day mortality was associated with delay to surgery ? 48 hours, whilst 30-day and 365-day mortality was associated with delay to surgery ≥ 48 hours, impaired cognition and cardiac/renal comorbidities. While the rate of acute kidney injury was similar to other studies, use of vasopressors and fluids to reduce the time spent at hypotensive levels failed to reduce this complication. Intra-operative hypotension at the levels observed in this cohort may not be an important determinant of acute kidney injury, postoperative mortality and length of stay.