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Multicenter Study
. 2025 May;42(5):435-444.
doi: 10.1007/s40266-025-01194-5. Epub 2025 Apr 29.

One-Year Survival and Postoperative Complications in Older Patients with Intertrochanteric Fractures: Association with Polypharmacy-A Multicenter Retrospective Cohort Study

Yasuhiko Takegami  1 , Yusuke Osawa  2 , Hiroto Funahashi  2 , Takamune Asamoto  2 , Hiroaki Ido  2 , Keiji Otaka  2 , Shinya Tanaka  2 , Hiroshi Asai  2 , Hiroyuki Yokoi  2 , Shiro Imagama  2
Affiliations
Multicenter Study

One-Year Survival and Postoperative Complications in Older Patients with Intertrochanteric Fractures: Association with Polypharmacy-A Multicenter Retrospective Cohort Study

Yasuhiko Takegami et al. Drugs Aging. 2025 May.

Abstract

Introduction: Polypharmacy is common in older patients and associated with adverse outcomes. However, the association with outcomes in patients with intertrochanteric fractures remains unclear. This study aimed to investigate associations between polypharmacy and 1-year survival (primary outcome) and postoperative complications (secondary outcome), in older patients undergoing surgical treatment for intertrochanteric fractures.

Patients and methods: This multicenter retrospective study initially identified 1864 patients who underwent surgical treatment for intertrochanteric fractures between 2016 and 2020. We excluded those aged < 65 years, with polytrauma, or with Charlson Comorbidity Index (CCI) > 3 or insufficient data. Patients were classified into polypharmacy (≥ 5 medications) and non-polypharmacy (< 5 medications) groups. We performed two analyses: (1) complete case analysis using 1:1 propensity score matching (498 pairs) with variables including age, sex, body mass index (BMI), CCI, residence before admission, fracture type, American Society of Anesthesiologists (ASA) physical status (PS), and Parker Mobility Score, followed by Kaplan-Meier survival analysis with log-rank test and chi-squared test for complications and (2) multivariate Cox regression analysis using multiple imputation (CART method, five imputed datasets) of the eligible cohort (N = 1608), adjusting for the same variables.

Results: In the matched cohort, the 1-year survival rate was significantly lower in the polypharmacy group (91.3%; 95% CI 87.7-93.8) compared with the non-polypharmacy group (94.0%; 95% CI 90.9-96.1; P = 0.027). Postoperative complications showed no significant differences between groups. Cox regression analysis revealed that advanced age, male sex, ASA-PS, and polypharmacy were associated with decreased survival, while higher Parker Mobility Score and normal and higher BMI showed improved survival.

Conclusions: Polypharmacy was associated with lower postoperative survival in older patients with intertrochanteric fractures and few comorbidities. As a potentially modifiable factor, medication review through multidisciplinary collaboration might contribute to improved outcomes.

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Conflict of interest statement

Declarations. Ethics Approval: This retrospective study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committees of all participating hospitals (approval number: 2020-564). Consent to Participate: The requirement for individual informed consent was waived by the ethics committees owing to the retrospective nature of the study. An opt-out approach was implemented, where information about the study was publicly posted at each participating institution. Consent for Publication: Not applicable. Availability of Data and Materials: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request. Code Availability: Statistical analyses were performed using EZR version 1.40 (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is freely available from: https://www.jichi.ac.jp/saitama-sct/SaitamaHP.files/statmedEN.html . Conflicts of Interest: None of the authors have any conflicts of interest to declare. Funding: Open Access funding provided by Nagoya University.

Figures

Fig. 1.
Fig. 1.
Flow diagram of patient selection and statistical analysis strategy. Study population was divided into two analytical approaches: propensity score matching analysis (analysis 1) and multivariate analysis using multiple imputation (analysis 2). Multiple imputation was performed using CART method with five imputed datasets and maximum five iterations. ASA American Society of Anesthesiologists physical status, BMI body mass index, CART classification and regression trees, CCI Charlson Comorbidity Index
Fig. 2
Fig. 2
Kaplan–Meier curve of survival rate after intertrochanteric fracture. The black solid line represents the non-polypharmacy group, and the red solid line represents the polypharmacy group
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