Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-11-2015 | Orthopaedic Surgery

Association between dementia and postoperative complications after hip fracture surgery in the elderly: analysis of 87,654 patients using a national administrative database

Authors: Yusuke Tsuda, Hideo Yasunaga, Hiromasa Horiguchi, Sumito Ogawa, Hirotaka Kawano, Sakae Tanaka

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2015

Abstract

Introduction

Mortality following hip fracture surgery is higher in patients with dementia than those without; however, few large-scale studies have investigated postoperative in-hospital complications in such patients. The aim of this study was to elucidate the complications that occur after hip fracture surgery in patients with and without dementia using a large national database.

Materials and methods

We retrospectively identified patients aged ≥70 years who underwent hemiarthroplasty, osteosynthesis for femoral neck fracture or osteosynthesis for intertrochanteric fracture, and compared the occurrence of postoperative complications between patients with and without dementia. Multivariate logistic regression analysis was performed to adjust for patient characteristics and hospital factors.

Results

A total of 87,654 patients were included in this study, including 9419 with dementia. Compared with the non-dementia group, the dementia group showed a higher incidence of overall postoperative complications [odds ratio (OR) 1.45; p < 0.001), surgical site infection (OR 1.58; p = 0.004), urinary tract infection (OR 1.87; p < 0.001) and respiratory complications (OR 1.49; p < 0.001). The rate of postoperative complications was higher for all types of hip fracture surgery. The occurrence of a postoperative complication was significantly higher in patients aged ≥80 years (OR 1.37; p < 0.001) and those with dementia (OR 1.45; p < 0.001), any type of malignancy (OR 1.42; p < 0.001), a history of cardiovascular disease (OR 1.33; p < 0.001), a history of cerebrovascular disease (OR 1.15; p = 0.029), chronic renal failure (OR 1.36; p < 0.001), liver cirrhosis (OR 1.41; p < 0.001) or blood transfusion after surgery (OR 1.49; p < 0.001).

Conclusions

Our results highlight the need to pay particular attention to surgical site infection, urinary tract infection and respiratory complications in patients with preoperative dementia after hip fracture surgery. These results provide additional useful evidence to inform the management of these patients.

Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018CrossRefPubMed

Hagino H, Sakamoto K, Harada A, Nakamura T, Mutoh Y, Mori S, Endo N, Nakano T, Itoi E, Kita K, Yamamoto N, Aoyagi K, Yamazaki K (2010) Nationwide one-decade survey of hip fractures in Japan. J Orthop Sci 15:737–745CrossRefPubMed

Wagner P, Fuentes P, Diaz A, Martinez F, Amenabar P, Schweitzer D, Botello E, Gac H (2012) Comparison of complications and length of hospital stay between orthopedic and orthogeriatric treatment in elderly patients with a hip fracture. Geriatr Orthop Surg Rehabil 3:55–58PubMedCentralCrossRefPubMed

Asada T (2012) Prevalence of dementia in Japan: past, present and future. Rinsho Shinkeigaku 52:962–964CrossRefPubMed

Lai SW, Chen YL, Lin CL, Liao KF (2013) Alzheimer’s disease correlates with greater risk of hip fracture in older people: a cohort in Taiwan. J Am Geriatr Soc 61:1231–1232CrossRefPubMed

Yasunaga H, Hashimoto H, Horiguchi H, Miyata S, Matsuda S (2012) Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database. BMC Health Serv Res 12:129PubMedCentralCrossRefPubMed

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMed

Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, Bruckner T, Satariano WA (2010) To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology 21:467–474CrossRefPubMed

Hu CJ, Liao CC, Chang CC, Wu CH, Chen TL (2012) Postoperative adverse outcomes in surgical patients with dementia: a retrospective cohort study. World J Surg 36:2051–2058CrossRefPubMed

10.

Shoda N, Yasunaga H, Horiguchi H, Matsuda S, Ohe K, Kadono Y, Tanaka S (2012) Risk factors affecting inhospital mortality after hip fracture: retrospective analysis using the Japanese Diagnosis Procedure Combination Database. BMJ 2(3). doi:10.1136/bmjopen-2011-000416

11.

Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Cocllo R (2005) Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg 87-B:844–850

12.

Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, Volicer L, Givens JL, Hamel MB (2009) The clinical course of advanced dementia. N Engl J Med 361:1529–1538PubMedCentralCrossRefPubMed

13.

Sue EE (2010) Dysphagia and aspiration pneumonia in older adults. J Am Acad Nurse Pract 22:17–22CrossRef

14.

Horner J, Alberts MJ, Dawson DV, Cook GM (1994) Swallowing in Alzheimer’s disease. Alzheimer Dis Assoc Disord 8:177–189CrossRefPubMed

15.

Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ (2002) The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 23:183–185CrossRefPubMed

16.

Stenvall M, Berggren M, Lundström M, Gustafson Y, Olofsson B (2012) A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia–subgroup analyses of a randomized controlled trial. Arch Gerontol Geriatr 54:284–289CrossRef

17.

Andrew DD, Sally-Anne P, Oliver S, Matthew M, Steffen JB, Leela CB (2012) Deep infection after hip fracture surgery: predictors of early mortality. Injury 43:1182–1186CrossRef

18.

Fakih MG, Heavens M, Ratcliffe CJ, Hendrich A (2013) First step to reducing infection risk as a system: evaluation of infection prevention processes for 71 hospitals. Am J Infect Control 41:950–954CrossRefPubMed

19.

Pugely AJ, Martin CT, Gao Y, Klocke NF, Callaghan JJ, Marsh JL (2013) A risk calculator for short-term morbidity and mortality following hip fracture surgery. J Orthop Trauma 28:63–69CrossRef

20.

Bozic KJ, Lau E, Kurtz S, Ong K, Rubash H, Vail TP, Berry DJ (2010) Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Jt Surg Am 94:794–800

21.

Liao JC, Chen WJ, Chen LH, Niu CC, Fu TS, Lai PL, Tsai TT (2013) Complications associated with instrumented lumbar surgery in patients with liver cirrhosis: a matched cohort analysis. Spine J 13:908–913CrossRefPubMed

22.

Banerjee S, Kapadia BH, Issa K, McElroy MJ, Khanuja HS, Harwin SF, Mont MA (2013) Postoperative blood loss prevention in total knee arthroplasty. J Knee Surg 26(6):395–400CrossRefPubMed

Title: Association between dementia and postoperative complications after hip fracture surgery in the elderly: analysis of 87,654 patients using a national administrative database
Authors: Yusuke Tsuda
Hideo Yasunaga
Hiromasa Horiguchi
Sumito Ogawa
Hirotaka Kawano
Sakae Tanaka
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 11/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2321-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between dementia and postoperative complications after hip fracture surgery in the elderly: analysis of 87,654 patients using a national administrative database

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2015

Platelet-rich plasma did not improve early healing of medial collateral ligament in rats

Navigation-assisted versus conventional total knee replacement: no difference in patient-reported outcome measures (PROMs) at 1 and 2 years

Elective removal of implants after open reduction and internal fixation of Tibial Plateau fractures improves clinical outcomes

Gap-balancing technique combined with patient-specific instrumentation in TKA

Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction

Cephalomedullary nails: factors associated with impingement of the anterior cortex of the femur in a Hispanic population