Excess mortality after pelvic fractures in institutionalized older people

Abstract

Mortality after pelvic fracture was calculated in residents of nursing homes. Compared with a matched comparison nonfracture group, excess mortality was found during the first 2 months after pelvic fracture.

Introduction: Low energy pelvic fractures are mainly observed in people of advanced older age. The incidence of these fractures has increased considerably during the last decades. Information about excess mortality after pelvic fractures in older people is not available.

Methods: To calculate excess mortality, a retrospective cohort study was conducted. Data from residents institutionalized in Bavarian nursing homes between 2001 and 2006 were used. For each patient with a pelvic fracture (n=1,154), five residents without pelvic fracture (n=5,770) were matched by sex, age, date of admission to the nursing home, and level of care (measure for the need of care). Hazard regression models were applied.

Results: An excess mortality was found during the first months after pelvic fracture. In women, the increased mortality risk was limited to the first (hazard rate ratio (HR) 1.83, 95% confidence interval (CI) 1.42-2.37) and second (HR 1.52, 95% CI 1.13-2.04) months after the injury. In men, excess mortality was more pronounced (HR 2.95, 95% CI 1.57-5.54 for the first month) and appeared to last longer than in women. The majority of deaths due to pelvic fractures in the first 2 months after injury occurred following discharge from the hospital to the nursing home.

Conclusion: Pelvic fractures are associated with an increased mortality. These results should encourage the development of preventive measures to reduce this excess mortality.