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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2023

Open Access 12-01-2023 | Original Article

A nationwide analysis on the interaction between frailty and beta-blocker therapy in hip fracture patients

Authors: Maximilian Peter Forssten, Ahmad Mohammad Ismail, Ioannis Ioannidis, Per Wretenberg, Tomas Borg, Yang Cao, Marcelo A. F. Ribeiro Jr., Shahin Mohseni

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2023

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Abstract

Introduction

Hip fracture patients, who are often frail, continue to be a challenge for healthcare systems with a high postoperative mortality rate. While beta-blocker therapy (BBt) has shown a strong association with reduced postoperative mortality, its effect in frail patients has yet to be determined. This study’s aim is to investigate how frailty, measured using the Orthopedic Hip Frailty Score (OFS), modifies the effect of preadmission beta-blocker therapy on mortality in hip fracture patients.

Methods

This retrospective register-based study included all adult patients in Sweden who suffered a traumatic hip fracture and subsequently underwent surgery between 2008 and 2017. Treatment effect was evaluated using the absolute risk reduction (ARR) in 30-day postoperative mortality when comparing patients with (BBt+) and without (BBt-) ongoing BBt. Inverse probability of treatment weighting (IPTW) was used to reduce potential confounding when examining the treatment effect. Patients were stratified based on their OFS (0, 1, 2, 3, 4 and 5) and the treatment effect was also assessed within each stratum.

Results

A total of 127,305 patients were included, of whom 39% had BBt. When IPTW was performed, there were no residual differences in observed baseline characteristics between the BBt+ and BBt- groups, across all strata. This analysis found that there was a stepwise increase in the ARRs for each additional point on the OFS. Non-frail BBt+ patients (OFS 0) exhibited an ARR of 2.2% [95% confidence interval (CI) 2.0–2.4%, p < 0.001], while the most frail BBt+ patients (OFS 5) had an ARR of 24% [95% CI 18–30%, p < 0.001], compared to BBt- patients within the same stratum.

Conclusion

Beta-blocker therapy is associated with a reduced risk of 30-day postoperative mortality in frail hip fracture patients, with a greater effect being observed with higher Orthopedic Hip Frailty Scores.
Appendix
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Metadata
Title
A nationwide analysis on the interaction between frailty and beta-blocker therapy in hip fracture patients
Authors
Maximilian Peter Forssten
Ahmad Mohammad Ismail
Ioannis Ioannidis
Per Wretenberg
Tomas Borg
Yang Cao
Marcelo A. F. Ribeiro Jr.
Shahin Mohseni
Publication date
12-01-2023
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-023-02219-7

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