Factors affecting mortality after hip fracture surgery: a retrospective analysis of 578 patients

Abstract

Purpose: To determine the effect of patient and surgical factors on mortality after hip fracture surgery.

Design: Retrospective study.

Setting: Level-one trauma and tertiary referral centers.

Methods: Patients were eligible if they were aged 65 years or older and had undergone surgery for a non-pathological femoral neck or intertrochanteric hip fracture between 2008 and 2011. The primary outcome was mortality: within the first year after surgery, after the first year, and survival as of the last questioning date. Of the 578 eligible patients, 399 (69%) were women; mean age was 79 years; and mean follow-up was 17 months.

Results: Mortality during the first year was significantly more frequent in patients aged 80 years or older (67 vs. 33%; P < 0.001). Estimated overall survival was significantly longer in women (43 vs. 37%; P = 0.01). The type of fracture had no impact on mortality (P = 0.96). Patients with high ASA class had a significant effect on mortality (P < 0.001). Surgery timing did not affect mortality in univariate analysis (P = 0.25). The mortality rate for hemiarthroplasty was higher than osteosynthesis options (P = 0.03). The effect of the type of anesthesia on mortality was not significant (P = 0.74).

Conclusions: Older men had the highest risk of mortality within the first year. Patients with ASA ratings of class 3 or 4 need to be evaluated carefully because they appear to be at higher risk of early mortality. Osteosynthesis has a lower mortality than does arthroplasty for hip fracture and thus should be preferred if either treatment is possible.

Level of evidence: IV.