Outcomes After Hip Fracture Surgery Compared With Elective Total Hip Replacement

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Public Health

Background:

• Patients undergoing hip fracture surgery face higher mortality and complication rates than those having elective total hip replacement (THR).
• The specific impact of advanced age and comorbidities on this increased perioperative risk in hip fracture patients remains unclear.

Purpose of the Study:

• To compare in-hospital mortality rates between hip fracture surgery and elective THR.
• To adjust for age, sex, and preoperative comorbidities in this comparison.

Main Methods:

• Utilized the French National Hospital Discharge Database (2010-2013) for patients over 45 undergoing hip surgery.
• Employed International Classification of Diseases, 10th Revision (ICD-10) codes to identify comorbidities and complications.
• Created matched cohorts (1:1 ratio) using multivariable logistic models and a greedy matching algorithm for age, sex, and comorbidities.

Main Results:

• Included 690,995 patients; 319,804 had hip fracture surgery and 371,191 had elective THR.
• Hip fracture surgery patients had higher in-hospital mortality (3.42% vs 0.18%) and major postoperative complications (5.88% vs 2.34%) compared to elective THR.
• Matched analysis confirmed significantly higher mortality (RR 5.88) and major complication (RR 2.50) risks for hip fracture surgery.

Conclusions:

• Hip fracture surgery is associated with a substantially higher risk of in-hospital mortality compared to elective THR, even after accounting for key patient factors.
• The findings highlight significant perioperative risks associated with hip fracture surgery.
• Further research is warranted to elucidate the specific causes underlying these observed differences in outcomes.