Incidence and causes of mortality following acute orthopaedic and trauma admissions

To analyse the incidence and causes of mortality of orthopaedic and trauma patients.

Between March 1995 and October 2000, there were 594 (404 females) in-patient deaths (2.8%) with a mean age of 82.14 years (range, 21-102 years) out of 21,122 acute admissions. The cause of death and details of the acute episode were collected from the hospital records, death certificates and postmortem examinations. Data collected were computerised and analysed using the Astute statistical package, University of Leeds.

The most common primary diagnosis on admission was fracture neck of femur 392 (69.1%; P = 0.001). In total, 443 (78.1%) patients underwent surgical intervention of their injuries prior to mortality with 21 patients (4.7%) dying on the same day of the operation. The mean number of days between the initial surgical intervention and death was 22.3 days (range, 0-154 days). Of the patients who were treated non-operatively, 124 died due to poor medical condition (4 [3.2%] died within 24 h, 66 [51.6%] died within the first week and the rest died thereafter). In the death certificate, the most common primary cause of death recorded in the group of patients of 64 years of age and below was cancer followed by multi-organ failure. In the age group of 65 years and above, the most common primary cause of mortality was pneumonia followed by heart failure and myocardial infarction.

In orthopaedic and trauma patients below the age of 65 years, the most common cause of death appears to be cancer followed by multiple system organ failure; in the elderly, pneumonia predominates followed by heart failure and myocardial infarction. Proximal femoral fractures accounted for 70% of the deaths.