Age and Comorbidity Contribute to Higher Death Risk Following Hip Fracture Surgery Save

Patients undergoing surgery for a hip fracture appear to have higher death rates than those having elective total hip replacement.  A study published in the September 15 issue of JAMA suggests being older and having more medical conditions are factors that may contribute to the higher risk of in-hospital death and major postoperative complications experienced by hip fracture surgery patients, .

Investigators at McMaster University examined if there was a difference in hospital mortality among patients who underwent hip fracture surgery relative to an elective THR, after adjustment for age, sex, and preoperative medical conditions. Using the French National Hospital Discharge Database, the researchers included patients older than 45 years who underwent hip surgery at French hospitals from January 2010 to December 2013.

A total of 690,995 eligible patients were included from 864 centers in France. Patients undergoing elective THR surgery (n = 371,191) were younger, more commonly men, and had less medical comorbidity compared with patients undergoing hip fracture surgery. Following hip fracture surgery (n = 319,804), 10,931 patients (3.4 percent) died before hospital discharge and 669 patients (0.18 percent) died after elective THR.

Analysis of the matched populations (n = 234,314) demonstrated a higher risk of mortality (1.8 percent for hip fracture surgery vs 0.3 percent for elective THR) and of major postoperative complications (5.9 percent for hip fracture surgery vs 2.3 percent for elective THR) among patients undergoing hip fracture surgery.

“If the absolute risk increases of 1.51 percent for in-hospital mortality and 3.54 percent for major postoperative complications were modifiable, they would be consistent with the number needed to treat 59 patients for in-hospital mortality and 28 patients for major postoperative complications. Hip fracture may be associated with physiologic processes that are not present in circumstances leading to elective THR and increase the risk of morbidity and mortality following surgery.”