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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 4/2018

Open Access 01-08-2018 | Original Article

Complications after hip fracture surgery: are they preventable?

Authors: E. R. Flikweert, K. W. Wendt, R. L. Diercks, G. J. Izaks, D. Landsheer, M. Stevens, I. H. F. Reininga

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2018

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Abstract

Purpose

Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention.

Methods

Prospective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality.

Results

The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97–2.35) and delay in surgery (OR 3.16; 95% CI 1.43–6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality.

Conclusion

The overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.
Literature
1.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.CrossRefPubMed
2.
3.
Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331(7529):1374.CrossRefPubMedPubMedCentral
4.
Kalisvaart KJ, de Jonghe JF, Bogaards MJ, Vreeswijk R, Egberts TC, Burger BJ, et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc. 2005;53(10):1658–66.CrossRefPubMed
5.
Hung WW, Egol KA, Zuckerman JD, Siu AL. Hip fracture management: tailoring care for the older patient. J Am Med Assoc. 2012;307(20):2185–94.CrossRef
6.
Belmont PJ Jr, Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg. 2014;134(5):597–604.CrossRefPubMed
7.
Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380–90.CrossRefPubMedPubMedCentral
8.
Lopez JG, Rossell CP, Remon JH, Gomez GC, Salvado GR, Coll BS. One-year outcome in older patients undergoing surgery for hip fractures. Results of a treatment protocol. Rev Orthop Traumatol. 2002;46(2):115–23.
9.
Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury. 2012;43(6):676–85.CrossRefPubMed
10.
Flikweert ER, Izaks GJ, Knobben BA, Stevens M, Wendt K. The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial. BMC Musculoskelet Disord. 2014;15:188.CrossRefPubMedPubMedCentral
11.
12.
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.CrossRefPubMed
13.
Leung AH, Lam TP, Cheung WH, Chan T, Sze PC, Lau T, et al. An orthogeriatric collaborative intervention program for fragility fractures: a retrospective cohort study. J Trauma. 2011;71(5):1390–4.CrossRefPubMed
14.
Dy CJ, Dossous PM, Ton QV, Hollenberg JP, Lorich DG, Lane JM. The medical orthopaedic trauma service: an innovative multidisciplinary team model that decreases in-hospital complications in patients with hip fractures. J Orthop Trauma. 2012;26(6):379–83.CrossRefPubMed
15.
Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007;19(2):197–214.CrossRefPubMed
16.
Deschodt M, Braes T, Flamaing J, Detroyer E, Broos P, Haentjens P, et al. Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc. 2012;60(4):733–9.CrossRefPubMed
17.
Brown CA, Boling J, Manson M, Owens T, Zura R. Relation between prefracture characteristics and perioperative complications in the elderly adult patient with hip fracture. South Med J. 2012;105(6):306–10.CrossRefPubMed
18.
Hansis M, Arens S, Wingenfeld C. Rate of infection in trauma surgery. An overview based on recent German language literature. Unfallchirurg. 1997;100(6):457–64.CrossRefPubMed
19.
Merrer J, Girou E, Lortat-Jacob A, Montravers P, Lucet JC. Groupe de Recherche sur l’Antibioprophylaxie en Chirurgie. Surgical site infection after surgery to repair femoral neck fracture: a French multicenter retrospective study. Infect Control Hosp Epidemiol. 2007;28(10):1169–74.CrossRefPubMed
20.
Murphy DK, Randell T, Brennan KL, Probe RA, Brennan ML. Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res. 2013;471(8):2691–702.CrossRefPubMedPubMedCentral
21.
Griffin J, Anthony TL, Murphy DK, Brennan KL, Brennan ML. What is the impact of age on reoperation rates for femoral neck fractures treated with internal fixation and hemiarthroplasty? A comparison of hip fracture outcomes in the very elderly population. J Orthop. 2016;13(1):33–9.CrossRefPubMedPubMedCentral
22.
Baumgarten M, Margolis DJ, Orwig DL, Shardell MD, Hawkes WG, Langenberg P, et al. Pressure ulcers in elderly patients with hip fracture across the continuum of care. J Am Geriatr Soc. 2009;57(5):863–70.CrossRefPubMedPubMedCentral
23.
Mak JC, Lattouf I, Narushevich A, Lai C, O’Rourke F, Shen Q, et al. A prospective review of hip fracture subtypes, surgical procedure, cognitive status, and analgesia use across four Australian hospitals. Geriatr Orthop Surg Rehabil. 2011;2(2):45–50.CrossRefPubMedPubMedCentral
24.
Fields AC, Dieterich JD, Buterbaugh K, Moucha CS. Short-term complications in hip fracture surgery using spinal versus general anaesthesia. Injury. 2015;46(4):719–23.CrossRefPubMed
25.
Parker MJ, Griffiths R. General versus regional anaesthesia for hip fractures. A pilot randomised controlled trial of 322 patients. Injury. 2015;46(8):1562–6.CrossRefPubMed
26.
Tung YC, Hsu YH, Chang GM. The effect of anesthetic type on outcomes of hip fracture surgery: a nationwide population-based study. Medicine (Baltimore). 2016;95(14):e3296.CrossRef
27.
Luger TJ, Kammerlander C, Gosch M, Luger MF, Kammerlander-Knauer U, Roth T, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporosis Int. 2010;21:S555–72.CrossRef
28.
Guay J, Parker MJ, Gajendragadkar PR, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016;2:CD000521.PubMed
29.
Oh ES, Li M, Fafowora TM, Inouye SK, Chen CH, Rosman LM, et al. Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review. Int J Geriatr Psychiatry. 2015;30(9):900–10.CrossRefPubMed
30.
Abraha I, Rimland JM, Trotta F, Pierini V, Cruz-Jentoft A, Soiza R, et al. Non-pharmacological interventions to prevent or treat delirium in older patients: clinical practice recommendations The SENATOR-ONTOP series. J Nutr Health Aging. 2016;20(9):927–36.CrossRefPubMed
31.
Landeiro F, Leal J, Gray AM. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporos Int. 2016;27(2):737–45.CrossRefPubMed
32.
Young J, Murthy L, Westby M, Akunne A, O’Mahony R. Guideline Development Group. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ. 2010;28(341):c3704.CrossRef
33.
Hussain M, Berger M, Eckenhoff RG, Seitz DP. General anesthetic and the risk of dementia in elderly patients: current insights. Clin Interv Aging. 2014;24(9):1619–28.
34.
Kamel HK, Iqbal MA, Mogallapu R, Maas D, Hoffmann RG. Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. J Gerontol A. 2003;58(11):1042–5.CrossRef
35.
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–51.CrossRefPubMed
Metadata
Title
Complications after hip fracture surgery: are they preventable?
Authors
E. R. Flikweert
K. W. Wendt
R. L. Diercks
G. J. Izaks
D. Landsheer
M. Stevens
I. H. F. Reininga
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-017-0826-2

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