Predictors of early mortality after hip fracture surgery.

PURPOSE: The aim of this study was to examine causes and potential risk factors for 30-day mortality after hip fracture surgery (HFS) at a high-volume tertiary-care hospital. METHODS: We retrospectively reviewed 467 patients who underwent HFS at our institution. Multivariate analysis was undertaken to identify potential predictors of early mortality. RESULTS: The 30-day mortality rate was 7.5% (35/467). The most common causes of death were pneumonia (37.1%, 13/35), acute coronary syndrome (31.4%, 11/35) and sepsis (14.3%, 5/35). Surgery after 48 hours of admission had a significantly higher 30-day mortality rate (11 % versus 4%, p = 0.006). There was a significant difference in age (p = 0.034), admission source (p < 0.001), preoperative haemoglobin (p < 0.001), walking ability (p = 0.004), number of comorbidities (p = 0.004) and pre-existing dementia (p = 0.01), cardiac disease (p < 0.001), chronic obstructive pulmonary disorder (COPD) (p = 0.036) and renal failure (p = 0.007) between the 30-day mortality group and the rest of the cohort. Surgical delay greater than 48 hours, admission source and pre-existing cardiac disease were identified as the strongest predictors of 30-day mortality. CONCLUSION: Surgical delay is an important but avoidable determinant of early mortality after HFS. Respiratory and cardiac function needs to be optimised postoperatively with early intervention in patients with signs of cardiovascular compromise or infection.

Reliability of measurements with digital radiographs--a myth.

The purpose of this study was to assess the accuracy of digital radiographs and hence their effectiveness in templating. The methodology involved a retrospective study of post operative radiographs of patients with hemiarthroplasty of the hip. Three observers made observations blinded to each other's measurements. A statistical analysis of the data highlights magnification varying from 6 to 31 percent. There is a statistically significant relationship between the size of the error (size measured on radiograph minus implant size, i.e. magnification) and the implant size (p = 0.005) but the percentage error (error/implant size x 100) is independent of implant size (p = 0.505). It is our impression that digital radiographs and templating on the digital radiographs should not be considered a precise process.