Perioperative Mortality for Patients with a Hip Fracture

Publication date: Available online 12 July 2017
Source:Injury
Author(s): Bassey Nkanang, Martyn Parker, Emily Parker, Richard Griffiths
IntroductionStudies on mortality following hip fracture surgery have hitherto focused on the 30day to 1year period and beyond. This study focuses on the immediate perioperative period. It examines mortality rates, patient characteristics, operative details and post-operative complications.Patients and MethodsA retrospective study of a hip fracture database in a large District General Hospital in the United Kingdom, from 1986 to 2015. A dataset of 9,393 patients was identified, including patients undergoing surgery for curative and palliative purposes, over fifteen years of age and with no upper age limit imposed. It compared patients who survived the first 48hours from start of surgery with those who died within this perioperative period.Results9,393 patients were treated surgically and included within this study, with a mean age of 80.13 and consisting of 7,130 female and 2,263 male patients. The all cause mortality within 48hours from start of surgery was 0.8% (72 patients). Increased risk of perioperative mortality was associated with increasing age, ASA grade 3 and above, in-hospital falls, impaired mobility prior to the fall and a reduced mental test score on admission. For the patient with a perioperative death, the most common circumstances identified in this study involved being found dead in bed by attending staff within 48hours of surgery.DiscussionThere has been significant attention paid to the optimization of patient management leading up to hip fracture surgery and its attendant impact on medium and longer term survival. The information from this study may be used to identify patients most at risk of death in the 48hours after surgery. The importance of this dataset is that it provides large numbers, which are needed in order to look for associations, given the low 48hour mortality rate found.ConclusionWe are unable to highlight any correctable or alterable factors associated with mortality. Further studies with detailed collection of data on a national scale may be needed to assess the impact of levels of postoperative care for hip fracture patients and perioperative mortality.



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