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Risk factors for post-hip fracture complications IDed

Sunday March 24, 2013
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In a study, researchers identified predictors of complications and mortality following a hip fracture.

Factors cited included dialysis, cardiac disease, diabetes and a longer time before surgery — the only modifiable risk factor when patients are hospitalized.

Each year, more than 340,000 Americans are hospitalized for hip fractures, according to background information in the study, which was presented March 21 in Chicago at the annual meeting of the American Academy of Orthopaedic Surgeons. According to AAOS data, 69% of hip fracture patients are female and 46% are between the ages of 65 and 84. Many hip fracture patients suffer complications with life-altering consequences. The estimated mortality rate within one year of a hip fracture ranges from 12% to 33%.

In the study, researchers used data from the 2008 National Sample Program of the National Trauma Data Bank to identify a representative sample of 44,419 hip fractures. The average patient’s age was 72.7, and 62% of patients were female. The researchers recorded patient demographics, medical comorbidities, injury-specific factors and outcomes, and developed a national estimate model for analysis.

Primary outcomes included mortality and the development of complications (4.5% and 12.5%, respectively). Of patients who sustained at least one complication, 17% died. Secondary measures consisted of the development of a major complication and specific complications such as pulmonary/cardiac complications, venous thromboembolic disease and infection. Hypertension and diabetes were the most common medical comorbidities among patients.

Dialysis, presenting in shock, cardiac disease, male sex and a high injury severity score were significant predictors of mortality.

Dialysis, shock, obesity, cardiac disease, diabetes and a greater time to surgery significantly influenced the risk of developing one or more postoperative complications. Obesity, femoral neck fracture, cardiac disease and diabetes significantly increased the risk of developing major complications.

The presence of shock following injury was the most important predictor of both cardiac and venous thromboembolic disease complications, multiplying the risk of cardiac complications by 10.

"Most of the predictors of complications and mortality are nonmodifiable," Philip J. Belmont Jr., MD, the lead author of the study and an orthopedic surgeon at the William Beaumont Medical Center in El Paso, Texas, said in a news release. "Reduced time to surgical intervention appears to be the single greatest factor with which a surgeon might influence the risk of mortality or complications."

A previous study showed a 41% increase in mortality if surgery is delayed 48 hours or more, according to the news release. The majority of patients are taken into surgery within 24 hours.

In older hip fracture patients, the pre-operative "work-up," and/or the correction of major clinical abnormalities can take more than one day, Belmont said. The potential benefit of correcting major clinical abnormalities prior to hip fracture surgery can influence survival. This process often can be expedited when the orthopedic surgeon works directly with the internal medicine physician or hospitalist who helps manage the patient.

"With the rising incidence of hip fractures, patient-treatment solutions directed toward this modifiable factor may reduce complications, and potentially mortality," Belmont said.

The study abstract is available at http://bit.ly/YIwriq.


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