Risk Factors for 30-Days Mortality After Proximal Femoral Fracture Surgery, a Cohort Study

Abstract

Purpose

The primary objective of this study was to identify new risk factors and to confirm previously reported risk factors associated with 30-day mortality after hip fracture surgery.

Patients and methods

A prospective hip fracture database was used to obtain data. In total, 3523 patients who underwent hip fracture surgery between 2011 and 2021 were included. Univariable and multivariable logistic regression was used to screen and identify candidate risk factors. Twenty-seven baseline factors and 16 peri-operative factors were included in the univariable analysis and 28 of those factors were included in multivariable analysis.

Results

8.6% of the patients who underwent hip fracture surgery died within 30 days after surgery. Prognostic factors associated with 30-day mortality after hip fracture surgery were as follows: age 90–100 years (OR = 4.7, 95% CI: 1.07–19.98, p = 0.041) and above 100 years (OR = 11.3, 95% CI: 1.28–100.26, p = 0.029), male gender (OR = 2.6, 95% CI: 1.97–3.33, p < 0.001), American Society of Anesthesiologists (ASA) 3 and ASA 4 (OR = 2.1, 95% CI: 1.44–3.14, p < 0.001), medical history of dementia (OR = 1.7, 95% CI: 1.25–2.36, p = 0.001), decreased albumin level (OR = 0.94, 95% CI: 0.92–0.97, p < 0.001), decreased glomerular filtration rate (GFR) (OR = 0.98, 95% CI: 0.98–0.99, p < 0.001), residential status of nursing home (OR = 2.1, 95% CI: 1.44–2.87, p < 0.001), higher Katz Index of Independence in Activities of Daily Living (KATZ-ADL) score (OR = 1.1, 95% CI: 1.01–1.16, p=0.018) and postoperative pneumonia (OR = 2.4, 95% CI: 1.72–3.38, p < 0.001).

Conclusion

A high mortality rate in patients after acute hip fracture surgery is known. Factors that are associated with an increased mortality are age above 90 years, male gender, ASA 3 and ASA 4, medical history of dementia, decreased albumin, decreased GFR, residential status of nursing home, higher KATZ-ADL score and postoperative pneumonia.

Keywords:

• hip fracture
• mortality
• independent risk factors
• clinical outcomes

Data Sharing Statement

on request.

Ethics Approval

The local Medical ethics committee approved the study and the study was registered in the Dutch Trial Register (nr NL 8313)

Consent to Participate

Due to the high percentage of cognitive dysfunction in the study population and since there were no changes in usual practice of care, the committee determined that patients’ consent to review medical charts was not required.

Consent for Publication

see consent to participate

Acknowledgments

This article is published on behalf of the Author collaborator group Dutch Hip Fracture RegistryCollaboration (DHFR): F. van Beek², J.M. van Buijtenen², B.I. Cleffken¹, A.G.J. van Marle², N.W.L. Schep¹, G.B. Schmidt², N.M.R. Soesman², J. Vermeulen¹, C.H. van der Vlies¹, O. Wijers².

¹Surgery Department, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands.

²Surgery Department, Franciscus Hospital, Rotterdam, Zuid-Holland, the Netherlands.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.