Predictors of Early Mortality in Geriatric Patients after Hemiarthroplasty for Femoral Neck Fracture

Yıl 2020, Cilt: 4 Sayı: 3, 220 - 225, 29.10.2020

Oğuzhan Tanoğlu Gökhun Arıcan Ahmet Özmeriç Özgür Şahin Serkan İltar Bahadır Alemdaroglu

https://doi.org/10.30565/medalanya.725992

Cited By: 4

Öz

Aim: Hemiarthroplasty is an appropriate treatment option for hip fractures that provides early mobilization, and good functional results. In the available literature, there are few studies that particulary investigate the risk factors affecting the 30-day mortality after hemiarthroplasty in geriatric patients with hip fractures. This study aimed to determine patient-related factors and biochemical predictors, which were easily accessible, inexpensive, and routinely examined in the perioperative period of 30-day mortality in geriatric patients after hemiarthroplasty for femoral neck fractures.

Methods: We enrolled 169 patients in our study, retrospectively. Age, body mass index, hospitalization time from admission to surgery, total hospitalization time, comorbidities, American Society of Anesthesiologists scores, blood transfusions, anticoagulant medications, albumin and plasma replacements, preoperative and postoperative hemogram, and biochemical tests were analyzed to determine the major predictors of 30-day mortality.

Results: The 30-day mortality rate was 14.2%. Multivariate analysis indicated increased age (>80 years of age) (1.095 odds ratio, p = 0.029), American Society of Anesthesiologists score (3.584 odds ratio, p = 0.007), and postoperative creatinine level (2.845 odds ratio, p = 0.001) as the major predictors of 30-day mortality after hemiarthroplasty for femoral neck fractures in geriatric patients.

Conclusion: Older age (>80 years of age), higher American Society of Anesthesiologists scores (ASA score 3 or 4) and increased postoperative creatinine levels were associated with an increased risk of 30-day mortality.

Anahtar Kelimeler

femoral neck fractures, hip fractures, creatinine, hip replacement arthroplasty, osteoporotic fractures, mortality

Teşekkür

Authors, thanks to Yusuf Kemal Arslan, PhD, Erzincan University Faculty of Medicine, Department of Biostatistics for their contribution.

Femur Boyun Kırığı nedeniyle Hemartroplasti Uygulanan Yaşlı hastalarda, Erken Mortalitenin Öngörücüleri

Öz

Amaç: Kalça kırıkları tedavisinde uygulanan hemiartroplasti ile erken mobilizasyon ve iyi fonksiyonel sonuçlar elde edilmektedir. Güncel literatürde, kalça kırığı olan geriatrik hastalarda hemiartroplasti sonrası 30 günlük mortaliteye etki eden risk faktörlerini araştıran az sayıda çalışma bulunmaktadır. Bu çalışmamızda, geriatrik femur boyun kırıklarında hemiartroplasti uygulaması sonrası 30 günlük mortaliteye etki eden hasta ile ilişkili faktörler, ucuz, rutin olarak kullanılan ve kolayca ulaşılabilen biyokimyasal belirteçlerin incelenmesi amaçlanmıştır.

Yöntemler: Çalışmamızda 169 hasta retrospektif olarak incelenmiştir. Yaş, vücut kitle indeksi, başvuru - ameliyat arası geçen süre, toplam yatış süreleri, komorbid hastalıklar, Amerikan Anestezi Derneği Skorları, kan transfüzyonu, antikoagülan ilaç kullanımı, albumin ve plazma replasmanları, ameliyat öncesi ve sonrası hemogram ve biyokimya testlerinin 30 günlük mortaliteye etkisi incelenmiştir.

Bulgular: 30 günlük mortalite oranı %14,2 olarak bulunmuştur. Çoklu değişkenler analizi sonucunda; yaş (>80 yaş) (1.095 odds ratio, p = 0.029), Amerikan Anestezi Derneği Skoru (3.584 odds ratio, p = 0.007) ve ameliyat sonrası kreatinin değerleri (2.845 odds ratio, p = 0.001), geriatrik femur boyun kırıkları için uygulanan hemiartroplasti sonrası 30 günlük mortalitenin ana belirleyicileri olarak bulunmuştur.

Sonuç: İleri yaş (>80 yaş), yüksek Amerikan Anestezi Derneği skorları (ASA skoru 3 veya 4) ve artmış ameliyat sonrası kreatinin değerleri, artmış 30 günlük mortalite riski ile ilişkili bulunmuştur.

Anahtar Kelimeler

femur boynu kırıkları, kalça kırıkları, kreatinin, kalça replasman artroplasti, osteoporotik kırıklar, mortalite

Kaynakça

• 1. Venkatesan M, Smith R, Balasubramanian S, Khan A, Uzoigwe C, Coats T et al. Serum lactate as a marker of mortality in patients with hip fracture: a prospective study. Injury 2015, 46(11):2201-2205. doi: 10.1016/j.injury.2015.06.038
• 2. Talsnes O, Hjelmstedt F, Dahl OE, Pripp AH, Reikerås O. Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly. Int Orthop 2011, 35(6):903-907. doi: 10.1007/s00264-010-1149-7
• 3. Talsnes O, Hjelmstedt F, Dahl OE, Pripp AH, Reikerås O. Biochemical lung, liver and kidney markers and early death among elderly following hip fracture. Int Arch Orthop Surg 2012, 132(12):1753-1758. doi: 10.1007/s00402-012-1611-7
• 4. 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. doi: 10.1136/bmj.h6246
• 5. Mangat KS, Mehra A, Yunas I, Nightingale P, Porter K. Is estimated peri-operative glomerular filtration rate associated with post-operative mortality in fractured neck of femur patients? Injury 2008, 39(10):1141-1146. doi: 10.1016/j.injury.2008.02.034
• 6. Bhaskar D, Parker MJ. Haematological indices as surrogate markers of factors affecting mortality after hip fracture. Injury 2011, 42(2):178-182. doi: 10.1016/j.injury.2010.07.501
• 7. Castronuovo E, Pezzotti P, Franzo A, Di Lallo D, Guasticchi G. Early and late mortality in elderly patients after hip fracture: a cohort study using administrative health databases in the Lazio region, Italy. BMC Geriatr 2011, 11(1):37. doi: 10.1186/1471-2318-11-37
• 8. Khan MA, Hossain FS, Ahmed I, Muthukumar N, Mohsen A. Predictors of early mortality after hip fracture surgery. Int Orthop 2013, 37(11):2119-2124. doi: 10.1007/s00264-013-2068-1
• 9. Nyholm AM, Gromov K, Palm H, Brix M, Kallemose T, Troelsen A et al. Time to surgery is associated with thirty-day and ninety-day mortality after proximal femoral fracture: a retrospective observational study on prospectively collected data from the Danish fracture database collaborators. J Bone Joint Surg 2015, 97(16):1333-1339. doi: 10.2106/JBJS.O.00029
• 10. Camurcu Y, Cobden A, Sofu H, Saklavci N, Kis M. What Are the Determinants of Mortality After Cemented Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients? J Arthroplasty 2017. doi: 10.1016/j.arth.2017.04.042
• 11. Yurdakul E, Karaaslan F, Korkmaz M, Duygulu F, Baktır A. Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients? Clin Interv Aging 2015, 10:1063. doi: 10.2147/CIA.S85039
• 12. Sebestyén A, Boncz I, Sándor J, Nyárády J. Effect of surgical delay on early mortality in patients with femoral neck fracture. Int Orthop 2008, 32(3):375-379. doi: 10.1007/s00264-007-0331-z
• 13. Meessen JM, Pisani S, Gambino ML, Bonarrigo D, van Schoor NM, Fozzato S et al. Assessment of mortality risk in elderly patients after proximal femoral fracture. Orthopedics 2014, 37(2):e194-e200. doi: 10.3928/01477447-20140124-25
• 14. Bretherton C, Parker M. Early surgery for patients with a fracture of the hip decreases 30-day mortality. Bone Joint J 2015, 97(1):104-108. doi: 10.1302/0301-620X.97B1.35041
• 15. Mariconda M, Costa G, Cerbasi S, Recano P, Aitanti E, Gambacorta M et al. The determinants of mortality and morbidity during the year following fracture of the hip. Bone Joint J 2015, 97(3):383-390. doi: 10.1302/0301-620X.97B3.34504
• 16. Ireland AW, Kelly PJ, Cumming RG. Risk factor profiles for early and delayed mortality after hip fracture: analyses of linked Australian Department of Veterans’ Affairs databases. Injury 2015, 46(6):1028-1035. doi: 10.1016/j.injury.2015.03.006
• 17. Lewis J, Hassan S, Wenn R, Moran C. Mortality and serum urea and electrolytes on admission for hip fracture patients. Injury 2006, 37(8):698-704. doi: 10.1016/j.injury.2006.04.121
• 18. Bennet SJ, Berry OM, Goddard J, Keating JF. Acute renal dysfunction following hip fracture. Injury 2010, 41(4):335-338. doi: 10.1016/j.injury.2009.07.009
• 19. Karres J, Kieviet N, Eerenberg J-P, Vrouenraets BC. Predicting early mortality following hip fracture surgery: the Hip fracture Estimator of Mortality Amsterdam (HEMA). J Orthop Trauma 2017. doi: 10.1097/BOT.0000000000001025
• 20. Porter CJ, Moppett IK, Juurlink I, Nightingale J, Moran CG, Devonald MA. Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury. BMC Nephrol 2017, 18(1):20. doi: 10.1186/s12882-017-0437-5
• 21. Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury 2009, 40(7):692-697. doi: 10.1016/j.injury.2009.01.010
• 22. Pedersen AB, Christiansen CF, Gammelager H, Kahlert J, Sørensen HT. Risk of acute renal failure and mortality after surgery for a fracture of the hip. Bone Joint J 2016, 98(8):1112-1118. doi: 10.1302/0301-620X.98B8.37497
• 23. Laulund AS, Lauritzen JB, Duus BR, Mosfeldt M, Jørgensen HL. Routine blood tests as predictors of mortality in hip fracture patients. Injury 2012, 43(7):1014-1020. doi: 10.1016/j.injury.2011.12.008
• 24. Bjorgul K, Novicoff WM, Saleh KJ. American Society of Anesthesiologist Physical Status score may be used as a comorbidity index in hip fracture surgery. J Arthroplasty 2010, 25(6):134-137. doi: 10.1016/j.arth.2010.04.010
• 25. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996, 77(2):217-222. doi: 10.1093/bja/77.2.217