Evaluation of risk factors and outcomes associated with mortality after hip fracture surgery in eldery patients

Abstract

Objective: In this retrospective study, it was aimed to compare mortality related risk factors and outcomes in patients who underwent proximal femoral nail and partial hip prosthesis for hip fracture. Material and Method: In our study, a total of 618 patient files who underwent hip fracture operations, including partial hip replacement (n=350) and proximal femoral nail (n=268) were retrospectively analyzed. Age, gender, fracture side, cause, type of fracture, type of operation, blood transfusion, hospital stay, anesthesia type and one-year survival times of the patients were examined. Results: Gender, age, side, mechanism, anesthesia, comorbid diseases, cause of mortality, one-year mortality and survival time differences between patient groups were not statistically significant (p>0.05). However, fracture type, blood transfusion and hospital stay differences between groups were statistically significant (p<0.05). According to the correlation analysis results, there was a statistically significant relationship between the type of operation and the type of fracture, blood transfusion and hospital stay (p<0.05). The difference between level of fracture type and blood transfusion level was statistically significant (p<0.05). The difference in length of hospital stay was not significant at the multivariate level (p> 0.05). The mean survival time of the hip prosthesis group (144.97±9.83) was greater than the survival time of the proximal femoral nail group (129.72±12.31), but this difference was not statistically significant (p> 0.05). Conclusion: According to the results of the research, both partial hip replacement and proximal femoral nail methods have similar results and mortality level. Therefore, methods including less invasive procedures should be preferred for the benefit of the patient in the selection of methods in hip fracture treatment.

Keywords

• hip fracture
• mortality
• hip replacement
• risk factors

References

1. Boutera A, Dybvik E, Hallan G, Gjertsen JE. Is there a weekend effect after hip fracture surgery? A study of 74,410 hip fractures reported to the Norwegian Hip Fracture Register. Acta Orthop 2020; 91: 63-8.
2. Zhang C, Feng J, Wang S, et al. Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study. PLoS Med 2020; 17: e1003180.
3. Bozkurt HH, Tokgöz MA, Yapar A and Atik OŞ. What is the importance of canal-to- diaphysis ratio on osteoporosis-related hip fractures? Eklem Hastalik Cerrahisi 2019; 30: 296-300.
4. Şener M, Onar V, Kazımoğlu C and Yağdı S. Parsiyel protez ile tedavi edilen yaşlı femur üst uç kırıklarında mortalite ve morbidite ilişkisi. Eklem Hastalıkları ve Cerrahisi 2009; 20: 11-7.
5. Kristoffersen MH, Dybvik E, Steihaug OM, et al. Validation of orthopaedic surgeons' assessment of cognitive function in patients with acute hip fracture. BMC Musculoskelet Disord 2019; 20: 268.
6. Pollmann CT, Rotterud JH, Gjertsen JE, Dahl FA, Lenvik O, Aroen A. Fast track hip fracture care and mortality - an observational study of 2230 patients. BMC Musculoskelet Disord 2019; 20: 248.
7. Alm CE, Frihagen F, Dybvik E, Matre K, Madsen JE, Gjertsen JE. Implants for trochanteric fractures in Norway: the role of the trochanteric stabilizing plate-a study on 20,902 fractures from the Norwegian hip fracture register 2011-2017. J Orthop Surg Res 2021; 16: 26.
8. Kjaervik C, Stensland E, Byhring HS, Gjertsen JE, Dybvik E, Soreide O. Hip fracture treatment in Norway: deviation from evidence-based treatment guidelines: data from the Norwegian Hip Fracture Register, 2014 to 2018. Bone Jt Open 2020; 1: 644-53.

9. Majoor BCJ, Leithner A, Van de Sande MAJ, Appelman-Dijkstra NM, Hamdy NAT, Dijkstra PDS. Individualized approach to the surgical management of fibrous dysplasia of the proximal femur. Orphanet J Rare Dis 2018; 13: 72.
10. Cauley JA, Cawthon PM, Peters KE, et al. Risk factors for hip fracture in older men: the Osteoporotic Fractures in Men Study (MrOS). J Bone Miner Res 2016; 31: 1810-9.
11. Zhang YW, Lu PP, Li YJ, et al. Prevalence, characteristics, and associated risk factors of the elderly with hip fractures: a cross-sectional analysis of NHANES 2005-2010. Clin Interv Aging 2021; 16: 177-85.
12. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 2010; 1: 6-14.
13. Yang Y, Komisar V, Shishov N, et al. The effect of fall biomechanics on risk for hip fracture in older adults: a cohort study of video-captured falls in long-term care. J Bone Miner Res 2020; 35: 1914-22.
14. Barnea R, Weiss Y, Abadi-Korek I, Shemer J. The epidemiology and economic burden of hip fractures in Israel. Isr J Health Policy Res 2018; 7: 38.
15. Dyer SM, Crotty M, Fairhall N, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016; 16: 158.
16. Lee SH, Chen IJ, Li YH, Fan Chiang CY, Chang CH, Hsieh PH. Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95,484 patients during 2006-2010. Acta Orthop Traumatol Turc 2016; 50: 437-42.
17. Von Friesendorff M, Besjakov J, Akesson K. Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J Bone Miner Res 2008; 23: 1832-41.
18. Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Mortality risk after hip fracture. J Orthop Trauma 2003; 1: 53-6.
19. Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 2002; 50: 1644-50.
20. Lu Y, Uppal HS. Hip fractures: relevant anatomy, classification, and biomechanics of fracture and fixation. Geriatr Orthop Surg Rehabil 2019; 10: 1-10.
21. Bentler SE, Liu L, Obrizan M, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009; 170: 1290-9.
22. Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures:Systematic literature review of German data and an overview of the international literature. Epidemiologie von Hüftfrakturen: Systematisches Literaturreview deutscher Daten und ein Überblick über die internationale Literatur. Z Gerontol Geriatr 2019; 52: 10-6.
23. Rapp K, Becker C, Lamb SE, Icks A, Klenk J. Hip fractures in institutionalized elderly people: incidence rates and excess mortality. J Bone Miner Res 2008; 23: 1825-31.
24. Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 2003; 56: 788-95.
25. Berry SD, Samelson EJ, Bordes M, Broe K, Kiel DP. Survival of aged nursing home residents With hip fracture.J Gerontol ABiol Sci Med Sci 2009; 64: 771-7.
26. Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J. Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res 2003; 18: 2231-7.