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. 2018 Sep 14;13(1):96.
doi: 10.1007/s11657-018-0515-8.

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

Daniel Prieto-Alhambra  1   2   3 , Carlen Reyes  4 , Miguel Sanz Sainz  5 , Jesús González-Macías  6 , Luis Gracia Delgado  7 , Cristina Alonso Bouzón  8 , Sarah Mills Gañan  9 , Damián Mifsut Miedes  10 , Eduardo Vaquero-Cervino  11 , Manuel Francisco Bravo Bardaji  12 , Laura Ezquerra Herrando  13 , Fátima Brañas Baztán  14 , Bartolomé Lladó Ferrer  15 , Ivan Perez-Coto  16 , Gaspar Adrados Bueno  17 , Jesús Mora-Fernandez  18 , Teresa Espallargas Doñate  19 , Jorge Martínez-Iñiguez Blasco  20 , Ignacio Aguado-Maestro  21 , Pilar Sáez-López  22 , Monica Salomó Doménech  23 , Vicente Climent-Peris  24 , Ángel Díez Rodríguez  25 , Humberto Kessel Sardiñas  26 , Óscar Tendero Gómez  27 , Jordi Teixidor Serra  28 , José Ramón Caeiro-Rey  29 , Ignacio Andrés Cano  30 , Mariano Barrés Carsi  31 , Iñigo Etxebarria-Foronda  32 , Juan Dionisio Avilés Hernández  33 , Juan Rodriguez Solis  34 , Oscar Torregrosa Suau  35 , Xavier Nogués  36 , Antonio Herrera  37 , Adolfo Díez-Perez  38
Affiliations

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

Daniel Prieto-Alhambra et al. Arch Osteoporos. .

Abstract

We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%.

Purpose: To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain.

Methods: Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described.

Results: A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively.

Conclusions: Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis.

Keywords: Hip fracture; Osteoporosis and patient care management; Registries.

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Conflict of interest statement

ADP is advisor or speaker for Amgen/UCB, Roche, Gilead. Institutional grant Amgen and Shareholder Active Life Sci. DPA’s research group has received unrestricted research grants from Servier, Amgen, and UCB; and speaker and consultancy fees from Amgen and UCB respectively. This work has been sponsored by an unrestricted grant of AMGEN to the Hospital del Mar Institute of Medical Investigation (IMIM). CR, MSS, JGM, LGD, CAB, SMG, DMM, EVC, MFBB, LEH, FBB, BLF, IPC, GAB, JMF, TED, JMIB, IAM, PSL, MSD, VCP, ADR, HKS, OTG, JTS, JRCR, IAC, MBC, IEF, JDAH, JRS, OTS, XN, and AH have no conflict of interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier estimates: cumulative mortality
Fig. 2
Fig. 2
Kaplan-Meier estimates: cumulative mortality stratified by sex
See this image and copyright information in PMC

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