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Open Access 07-11-2024 | Osteoporosis | Original Article

Nationwide database study of postoperative sequelae and in-hospital mortality in super-elderly hip fracture patients

Authors: Yu Mori, Kunio Tarasawa, Hidetatsu Tanaka, Naoko Mori, Kiyohide Fushimi, Toshimi Aizawa, Kenji Fujimori

Published in: Journal of Bone and Mineral Metabolism

Abstract

Introduction

The risk of postoperative sequelae and in-hospital mortality in Japanese patients aged 90 years and older with hip fractures is unexplored. This study aims to use a comprehensive medical claims database in Japan to compare super-elderly patients aged 90 years and older with elderly aged 65–89 and clarify the risk of sequelae and in-hospital mortality in super-elderly patients.

Materials and methods

We retrospectively analyzed the Diagnosis Procedure Combination (DPC) database for all of Japan from April 2016 to March 2022. Medical records from approximately 1100 DPC-related hospitals were provided with consistent consent during this period. In this study, we focused on super-elderly patients and examined the association with the risk of postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after one-to-one propensity score matching.

Results

After performing propensity score matching based on sex and comorbidities, 129,953 pairs of patients were identified. These pairs were compared to elderly and super-elderly patients. The results of this study showed that compared with hip fractures in the elderly, hip fractures in the super-elderly were associated with an increased risk of pneumonia, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after adjustment for confounders. The odds ratio of in-hospital mortality was 2.190 (95% CI 2.062–2.325).

Conclusion

As it has been shown that super-elderly patients with hip fractures are at greater risk of respiratory and urinary tract infections and increased in-hospital mortality, careful attention should be required for perioperative management.

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Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 51:364–370. https://doi.org/10.1046/j.1532-5415.2003.51110.xCrossRefPubMed

Chrischilles E, Shireman T, Wallace R (1994) Costs and health effects of osteoporotic fractures. Bone 15:377–386. https://doi.org/10.1016/8756-3282(94)90813-3CrossRefPubMed

Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413. https://doi.org/10.1007/pl00004148CrossRefPubMed

Brown CA, Starr AZ, Nunley JA (2012) Analysis of past secular trends of hip fractures and predicted number in the future 2010–2050. J Orthop Trauma 26:117–122. https://doi.org/10.1097/BOT.0b013e318219c61aCrossRefPubMed

Tamaki J, Fujimori K, Ikehara S, Kamiya K, Nakatoh S, Okimoto N, Ogawa S, Ishii S, Iki M, Working Group of Japan Osteoporosis F (2019) Estimates of hip fracture incidence in Japan using the National Health Insurance Claim Database in 2012–2015. Osteoporos Int 30:975–983. https://doi.org/10.1007/s00198-019-04844-8CrossRef

Yamamoto N, Sawaguchi T, Matsushita T, Katoh N, Arai H, Shirahama M, Endo N, Hagino H, Mori S, Teramoto T, Ookuro M, Hiraoka M, Takahashi HE (2024) Fragility fracture network-japan: the challenge of establishment of a national hip fracture database and successful achievement of nationwide health system change for hip fracture care in Japan. Injury. https://doi.org/10.1016/j.injury.2024.111452CrossRefPubMed

Giannoulis D, Calori GM, Giannoudis PV (2016) Thirty-day mortality after hip fractures: has anything changed? Eur J Orthop Surg Traumatol 26:365–370. https://doi.org/10.1007/s00590-016-1744-4CrossRefPubMedPubMedCentral

Bible JE, Wegner A, McClure DJ, Kadakia RJ, Richards JE, Bauer JM, Mir HR (2014) One-year mortality after acetabular fractures in elderly patients presenting to a level-1 trauma center. J Orthop Trauma 28:154–159. https://doi.org/10.1097/BOT.0b013e31829e801bCrossRefPubMed

Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374. https://doi.org/10.1136/bmj.38643.663843.55CrossRefPubMedPubMedCentral

10.

Liu Y, Zhang CW, Zhao XD (2020) Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment. BMC Musculoskelet Disord 21:217. https://doi.org/10.1186/s12891-020-03249-7CrossRefPubMedPubMedCentral

11.

Lin WT, Chao CM, Liu HC, Li YJ, Lee WJ, Lai CC (2015) Short-term outcomes of hip fractures in patients aged 90 years old and over receiving surgical intervention. PLoS ONE 10:e0125496. https://doi.org/10.1371/journal.pone.0125496CrossRefPubMedPubMedCentral

12.

van de Kerkhove MP, Antheunis PS, Luitse JS, Goslings JC (2008) Hip fractures in nonagenarians: perioperative mortality and survival. Injury 39:244–248. https://doi.org/10.1016/j.injury.2007.07.009CrossRefPubMed

13.

Chia PH, Gualano L, Seevanayagam S, Weinberg L (2013) Outcomes following fractured neck of femurin an Australian metropolitan teaching hospital. Bone Joint Res 2:162–168. https://doi.org/10.1302/2046-3758.28.2000177CrossRefPubMedPubMedCentral

14.

Lin JC, Liang WM (2017) Mortality, readmission, and reoperation after hip fracture in nonagenarians. BMC Musculoskelet Disord 18:144. https://doi.org/10.1186/s12891-017-1493-5CrossRefPubMedPubMedCentral

15.

Wang SH, Chang CW, Chai SW, Huang TS, Soong R, Lau NC, Chien CY (2024) Surgical intervention may provides better outcomes for hip fracture in nonagenarian patients: A retrospective observational study. Heliyon 10:e25151. https://doi.org/10.1016/j.heliyon.2024.e25151CrossRefPubMedPubMedCentral

16.

Mori Y, Tarasawa K, Tanaka H, Mori N, Fushimi K, Fujimori K, Aizawa T (2024) Surgery on admission and following day reduces hip fracture complications: a Japanese DPC study. J Bone Miner Metab. https://doi.org/10.1007/s00774-024-01534-2CrossRefPubMedPubMedCentral

17.

Mori Y, Tarasawa K, Tanaka H, Mori N, Fushimi K, Fujimori K, Aizawa T (2024) Does total hip arthroplasty in elderly patients with femoral neck fractures reduce complications?: A Japanese DPC study. J Orthop Sci. https://doi.org/10.1016/j.jos.2024.06.011CrossRefPubMed

18.

Tanaka H, Tarasawa K, Mori Y, Fushimi K, Fujimori K, Aizawa T (2024) Surgery within Two Days of Admission Reduces Complications and Mortality of Patients with Trochanteric Femur Fractures: A Japanese DPC Study. Tohoku J Exp Med. https://doi.org/10.1620/tjem.2024.J093CrossRefPubMed

19.

Matsuda S (2016) Development of case mix based evaluation system in Japan. Jpn Hosp. https://doi.org/10.7223/apjdm.4.55CrossRefPubMed

20.

Mori Y, Tarasawa K, Tanaka H, Mori N, Kanabuchi R, Fushimi K, Aizawa T, Fujimori K (2024) Rheumatoid arthritis increases complication risks in elderly hip fracture patients: A Japanese nationwide medical claims database study. Mod Rheumatol. https://doi.org/10.1093/mr/roae088CrossRefPubMed

21.

Parvizi J, Ereth MH, Lewallen DG (2004) Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am 86:1983–1988. https://doi.org/10.2106/00004623-200409000-00017CrossRefPubMed

22.

Smith T, Pelpola K, Ball M, Ong A, Myint PK (2014) Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 43:464–471. https://doi.org/10.1093/ageing/afu065CrossRefPubMed

23.

Pedersen AB, Christiansen CF, Gammelager H, Kahlert J, Sorensen HT (2016) Risk of acute renal failure and mortality after surgery for a fracture of the hip: a population-based cohort study. Bone Joint J. https://doi.org/10.1302/0301-620X.98B8.37497CrossRefPubMed

24.

Castronuovo E, Pezzotti P, Franzo A, Di Lallo D, Guasticchi G (2011) Early and late mortality in elderly patients after hip fracture: a cohort study using administrative health databases in the Lazio region. Italy BMC Geriatr 11:37. https://doi.org/10.1186/1471-2318-11-37CrossRefPubMed

25.

Sircar P, Godkar D, Mahgerefteh S, Chambers K, Niranjan S, Cucco R (2007) Morbidity and mortality among patients with hip fractures surgically repaired within and after 48 hours. Am J Ther 14:508–513. https://doi.org/10.1097/01.pap.0000249906.08602.a6CrossRefPubMed

26.

Rosso F, Dettoni F, Bonasia DE, Olivero F, Mattei L, Bruzzone M, Marmotti A, Rossi R (2016) Prognostic factors for mortality after hip fracture: Operation within 48 hours is mandatory. Injury 47:S91–S97. https://doi.org/10.1016/j.injury.2016.07.055CrossRefPubMed

27.

Groff H, Kheir MM, George J, Azboy I, Higuera CA, Parvizi J (2020) Causes of in-hospital mortality after hip fractures in the elderly. Hip Int 30:204–209. https://doi.org/10.1177/1120700019835160CrossRefPubMed

28.

Liang W, Qin G, Yu L, Wang Y (2023) Reducing complications of femoral neck fracture management: a retrospective study on the application of multidisciplinary team. BMC Musculoskelet Disord 24:338. https://doi.org/10.1186/s12891-023-06455-1CrossRefPubMedPubMedCentral

29.

Mori Y, Izumiyama T, Kurishima H, Kamimura M, Baba K, Mori N, Itoi E (2021) Effect of denosumab switched from bisphosphonates in preventing joint destruction in postmenopausal rheumatoid arthritis patients with anti-cyclic citrullinated peptide antibodies. J Orthop Surg Res 16:107. https://doi.org/10.1186/s13018-021-02271-2CrossRefPubMedPubMedCentral

30.

Ebina K, Etani Y, Noguchi T, Nakata K, Okada S (2024) Clinical effects of teriparatide, abaloparatide, and romosozumab in postmenopausal osteoporosis. J Bone Miner Metab. https://doi.org/10.1007/s00774-024-01536-0CrossRefPubMedPubMedCentral

31.

Ishizu H, Shimizu T, Yamazaki S, Ohashi Y, Sato K, Shimodan S, Iwasaki N (2023) Secondary fracture rates and risk factors 1 year after a proximal femoral fracture under FLS. J Bone Miner Metab 41:542–549. https://doi.org/10.1007/s00774-023-01426-xCrossRefPubMed

Title: Nationwide database study of postoperative sequelae and in-hospital mortality in super-elderly hip fracture patients
Authors: Yu Mori
Kunio Tarasawa
Hidetatsu Tanaka
Naoko Mori
Kiyohide Fushimi
Toshimi Aizawa
Kenji Fujimori
Publication date: 07-11-2024
Publisher: Springer Nature Singapore
Keywords: Osteoporosis
Osteoporosis
Urinary Tract Infection
Published in: Journal of Bone and Mineral Metabolism
Print ISSN: 0914-8779
Electronic ISSN: 1435-5604
DOI: https://doi.org/10.1007/s00774-024-01564-w

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