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Observational Study
. 2022 Apr;48(2):743-751.
doi: 10.1007/s00068-020-01588-7. Epub 2021 Jan 28.

A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

Rebecka Ahl  1   2   3 , Ahmad Mohammad Ismail  3   4 , Tomas Borg  3   4 , Gabriel Sjölin  3   5 , Maximilian Peter Forssten  3   4 , Yang Cao  6 , Per Wretenberg  3   4 , Shahin Mohseni  7   8
Affiliations
Observational Study

A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

Rebecka Ahl et al. Eur J Trauma Emerg Surg. 2022 Apr.

Abstract

Purpose: Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery.

Methods: This is a retrospective nationwide observational cohort study. All adults [Formula: see text] 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality.

Results: 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26-0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure.

Conclusions: Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

Keywords: Beta-blockers; Hip fractures; Mortality.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flow chart describing patient selection. *Pathological fractures were not extracted
See this image and copyright information in PMC

References

    1. Gundel O, Thygesen LC, Gögenur I, et al. Postoperative mortality after a hip fracture over a 15-year period in Denmark: a national register study. Acta Orthop. 2020;91:58–62. doi: 10.1080/17453674.2019.1680485. - DOI - PMC - PubMed
    1. Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–1579. doi: 10.1001/jama.2009.1462. - DOI - PMC - PubMed
    1. Rutenberg TF, Assaly A, Vitenberg M, et al. Outcome of non-surgical treatment of proximal femur fractures in the fragile elderly population. Injury. 2019;50:1347–1352. doi: 10.1016/j.injury.2019.05.022. - DOI - PubMed
    1. Rikshoft. 2018. Rikshoft Arsrapport. https://rikshoft.se/wp-content/uploads/2019/11/rikshoft_rapport2018_1910.... Accessed 10 Feb 2020.
    1. United Health Foundation. American’s health rankings, senior report. https://www.americashealthrankings.org/explore/senior/measure/hip_fractu.... Accessed 1 May 2020.

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