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Published on: August 17, 2017
Comorbidity as the dominant predictor of mortality after hip fracture surgeries
Eric Wei Liang Cher1, John Carson Allen2, Tet Sen Howe3
1Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore. ericcher@gmail.com.
Insights
Comorbidities, measured by the Charlson Comorbidity Index (CCI), are more critical than surgical delay in predicting mortality after hip fracture surgery. A higher CCI significantly impacts patient survival outcomes.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Public Health
Background:
- Hip fractures represent a significant and increasing health concern.
- Delayed surgical intervention for hip fractures is often linked to adverse patient outcomes.
- The Charlson Comorbidity Index (CCI) is a widely used measure of patient comorbidity burden.
Purpose of the Study:
- To investigate the association between surgical delay and comorbidities (using CCI) with mortality risk following hip fracture surgery.
- To determine whether surgical delay or CCI is the dominant predictor of mortality.
- To assess the impact of CCI on short-term and long-term survival.
Main Methods:
- A retrospective analysis of 1004 hip fracture patients treated between January 2013 and December 2015.
- Data collected included age, gender, CCI, surgical delay, fracture patterns, and ASA score.
- Mortality outcomes were analyzed at inpatient, 30-day, 90-day, and 2-year intervals.
Main Results:
- Mortality rates were 1.1% inpatient, 1.8% at 30 days, 2.7% at 90 days, and 13.3% at 2 years.
- The Charlson Comorbidity Index (CCI) consistently emerged as the dominant predictor for both short-term and long-term mortality.
- A CCI score of 5 or higher indicated a greater mortality risk from comorbidities than from surgical delay.
Conclusions:
- The Charlson Comorbidity Index (CCI) is a more significant predictor of mortality than surgical delay in patients undergoing hip fracture surgery.
- CCI plays a vital role in the prognostication of survival for hip fracture patients.
- Clinical decision-making and risk stratification should prioritize assessment of patient comorbidities.
Abstract:
The aim of this study was to investigate the association of surgical delay and comorbidities with the risk of mortality after hip fracture surgeries. We found that CCI was the dominant factor in predicting both short- and long-term mortality, and its effect is vital in the prognostication of survivorship.
Introduction:
Hip fracture is a growing concern and a delay in surgery is often associated with a poorer outcome. We hypothesized that a higher Charlson Comorbidity Index (CCI) portends greater risk of mortality than a delay in surgery. Our aim was to investigate the associations of surgical delay and CCI with risk of mortality and to determine the dominant predictor.
Methods:
This retrospective study examines hip fracture data from a large tertiary hospital in Singapore over the period January 2013 through December 2015. Data collected included age, gender, CCI, delay of surgery, fracture patterns, and the American Society of Anaesthesiologist (ASA) score. Post-operative outcomes analyzed included mortality at inpatient, at 30 and 90 days, and at 2 years.
Results:
A total of 1004 patients with hip fractures were included in this study. Study mortality rates were 1.1% (n = 11) during in-hospital admission, 1.8% (n = 18) at 30 days, 2.7% (n = 27) at 90 days, and 13.3% (n = 129) at 2 years. Lost to follow-up rate at 2 years was 3.3%. We found that CCI was consistently the dominant factor in predicting both short- and long-term mortality. A CCI score of 5 was identified as the inflection point above which comorbidity at baseline presented a greater risk of mortality than a delay in surgery.
Conclusion:
Our analysis showed that CCI is the dominant predictor of both short- and long-term mortality compared with delay in surgery. The effect of CCI is vital in the prognostication of mortality in patients surgically treated for hip fractures.
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