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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2018 | Research article

One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry

Authors: Simon Kwoon-Ho Chow, Jiang-hui Qin, Ronald Man-Yeung Wong, Wai-Fan Yuen, Wai-Kit Ngai, Ning Tang, Chor-Yin Lam, Tak-Wing Lau, Kin-Bong Lee, Kwai Ming Siu, Sze-Hung Wong, Tracy Y. Zhu, Wing-Hoi Cheung, Kwok-Sui Leung

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

The purpose of this registry-based retrospective study was to investigate the risk factors related to one-year mortality in displaced intracapsular fragility hip fracture patients.

Methods

Patients were screened from the Fragility Fracture Registry. Inclusion criterion was displaced intracapsular hip fracture patients with atypical or pathological fractures excluded. One-year mortality was investigated against risk factors including age, gender, past medical history, pre-fracture mobility (PFM), pre-operation ASA grade, delayed surgery over 48 h, post-surgical complications, and length of stay at acute orthopedic ward (LOS).

Results

A total of 1050 patients were included for further analysis. Gross one-year mortality was 14.9%. One-year mortality was significantly higher in patients who received non-operative treatment and those who received surgery but delayed over 48 h after admission (both p < 0.001). Male gender (OR = 2.708), advanced age (OR = 1.359), higher risk ASA grades (III to V) (OR = 1.990), past history of gastrointestinal disease (OR = 1.671), and renal impairment (OR = 1.984) were related to higher one-year mortality. The mortality of patients in PFM grade 3 and LOS group 3 was significantly higher (OR = 2.240 and 1.722, respectively).

Conclusions

Higher age, male gender, past gastrointestinal disease and renal impairment, ASA grade over 3, indoor confined pre-fracture ambulatory, and stay at hospital over 15 days were risk factors related to higher one-year mortality in surgically treated displaced intracapsular hip fracture patients. A multi-disciplinary approach is advised to patients identified with these risks factors and co-managed by orthopedic surgeons, geriatricians, and fracture liaison nurses.

Brown JP, Josse RG. Scientific Advisory Council of the Osteoporosis Society of C: 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002;167:S1–34.PubMedPubMedCentral

Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR. Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health. 1997;87:1630–6.CrossRefPubMedPubMedCentral

Omsland TK, Emaus N, Tell GS, Magnus JH, Ahmed LA, Holvik K, Center J, Forsmo S, Gjesdal CG, Schei B, et al. Mortality following the first hip fracture in Norwegian women and men (1999-2008). A NOREPOS study. Bone. 2014;63:81–6.CrossRefPubMed

Brainsky A, Glick H, Lydick E, Epstein R, Fox KM, Hawkes W, Kashner TM, Zimmerman SI, Magaziner J. The economic cost of hip fractures in community-dwelling older adults: a prospective study. J Am Geriatr Soc. 1997;45:281–7.CrossRefPubMed

Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int. 2005;16(Suppl 2):S3–7.CrossRefPubMed

Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA. Epidemiology ICWGoF: secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. 2011;22:1277–88.CrossRefPubMedPubMedCentral

Lau EM, Cooper C, Fung H, Lam D, Tsang KK. Hip fracture in Hong Kong over the last decade--a comparison with the UK. J Public Health Med. 1999;21:249–50.CrossRefPubMed

Koh LK, Saw SM, Lee JJ, Leong KH, Lee J. National Working Committee on O: hip fracture incidence rates in Singapore 1991-1998. Osteoporos Int. 2001;12:311–8.CrossRefPubMed

Leung KS, Yuen WF, Ngai WK, Lam CY, Lau TW, Lee KB, Siu KM, Tang N, Wong SH, Cheung WH. How well are we managing fragility hip fractures? A narrative report on the review with the attempt to setup a Fragility Fracture Registry in Hong Kong. Hong Kong Med J. 2017;23:264–71.PubMed

10.

Paksima N, Koval KJ, Aharanoff G, Walsh M, Kubiak EN, Zuckerman JD, Egol KA. Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis. 2008;66:111–7.PubMed

11.

Karademir G, Bilgin Y, Ersen A, Polat G, Buget MI, Demirel M, Balci HI. Hip fractures in patients older than 75 years old: retrospective analysis for prognostic factors. Int J Surg. 2015;24:101–4.CrossRefPubMed

12.

Iosifidis M, Iliopoulos E, Panagiotou A, Apostolidis K, Traios S, Giantsis G. Walking ability before and after a hip fracture in elderly predict greater long-term survivorship. J Orthop Sci. 2016;21:48–52.CrossRefPubMed

13.

Ekstrom W, Samuelsson B, Ponzer S, Cederholm T, Thorngren KG, Hedstrom M. Sex effects on short-term complications after hip fracture: a prospective cohort study. Clin Interv Aging. 2015;10:1259–66.CrossRefPubMedPubMedCentral

14.

Man LP, Ho AW, Wong SH. Excess mortality for operated geriatric hip fracture in Hong Kong. Hong Kong Med J. 2016;22:6–10.PubMed

15.

Nikkel LE, Kates SL, Schreck M, Maceroli M, Mahmood B, Elfar JC. Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study. BMJ. 2015;351:h6246.CrossRefPubMedPubMedCentral

16.

Nordstrom P, Gustafson Y, Michaelsson K, Nordstrom A. Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ. 2015;350:h696.CrossRefPubMedPubMedCentral

17.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.CrossRefPubMed

18.

Choi HG, Lee YB, Rhyu SH, Kwon BC, Lee JK. Mortality and cause of death postoperatively in patients with a hip fracture: a national cohort longitudinal follow-up study. Bone Joint J. 2018;100B:436–42.CrossRef

19.

Dokladalova P, Majernicek M, Vaculik J, Kubes R, Schwarz O, Dungl P. Results of surgically treated patients for hip fracture - complications, mortality. Acta Chir Orthop Traumatol Cech. 2017;84:424–30.PubMed

20.

Pioli G, Lauretani F, Pellicciotti F, Pignedoli P, Bendini C, Davoli ML, Martini E, Zagatti A, Giordano A, Nardelli A, et al. Modifiable and non-modifiable risk factors affecting walking recovery after hip fracture. Osteoporos Int. 2016;27(6):2009–16.CrossRefPubMed

21.

Lund CA, Moller AM, Wetterslev J, Lundstrom LH. Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery. PLoS One. 2014;9:e99308.CrossRefPubMedPubMedCentral

22.

Menendez-Colino R, Alarcon T, Gotor P, Queipo R, Ramirez-Martin R, Otero A, Gonzalez-Montalvo JI. Baseline and pre-operative 1-year mortality risk factors in a cohort of 509 hip fracture patients consecutively admitted to a co-managed orthogeriatric unit (FONDA cohort). Injury. 2018;49:656–61.CrossRefPubMed

23.

Shenouda M, Silk Z, Radha S, Bouanem E, Radford W. The introduction of a multidisciplinary hip fracture pathway to optimise patient care and reduce mortality: a prospective audit of 161 patients. Open Orthop J. 2017;11:309–15.CrossRefPubMedPubMedCentral

24.

Wallace R, Angus LDG, Munnangi S, Shukry S, DiGiacomo JC, Ruotolo C. Improved outcomes following implementation of a multidisciplinary care pathway for elderly hip fractures. Aging Clin Exp Res. 2018; https://doi.org/10.1007/s40520-018-0952-7.

25.

Soderqvist A, Ekstrom W, Ponzer S, Pettersson H, Cederholm T, Dalen N, Hedstrom M, Tidermark J. : prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology. 2009;55:496–504.CrossRefPubMed

26.

Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43:464–71.CrossRefPubMed

Title: One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry
Authors: Simon Kwoon-Ho Chow
Jiang-hui Qin
Ronald Man-Yeung Wong
Wai-Fan Yuen
Wai-Kit Ngai
Ning Tang
Chor-Yin Lam
Tak-Wing Lau
Kin-Bong Lee
Kwai Ming Siu
Sze-Hung Wong
Tracy Y. Zhu
Wing-Hoi Cheung
Kwok-Sui Leung
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-0936-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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