One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study
Mattia Morri1, Elisa Ambrosi2, Paolo Chiari3
1Servizio di Assistenza Infermieristica, Tecnica e Riabilitativa, Rizzoli Orthopedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
Insights
Older adults with hip fractures face a significantly higher risk of one-year mortality. Key predictors include advanced age, higher comorbidity scores, pressure ulcers, and inability to regain ambulation post-surgery.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Public Health
Background:
- Hip fractures in older adults are associated with a 3-4 times higher mortality rate within one year compared to the general population.
- Identifying predictive factors for one-year mortality is crucial for improving patient outcomes and healthcare resource allocation.
Purpose of the Study:
- To identify independent predictive factors associated with one-year mortality after hip fracture surgery in patients aged 65 years and older.
- To assess the predictive capacity of identified factors using Receiver Operating Characteristic (ROC) curve analysis.
Main Methods:
- Prospective prognostic cohort study involving 1083 elderly patients (≥65 years) admitted for fragility hip fractures across three Italian hospitals.
- Exclusion of patients with periprosthetic or pathological fractures.
- Multivariate analysis and ROC curve analysis were employed to determine significant predictors and their predictive capacity for one-year mortality.
Main Results:
- 16.6% of patients died within one year post-surgery.
- Independent predictors of one-year mortality included advancing age (OR=1.094), higher baseline Charlson Index (OR=1.257), higher Activities of Daily Living (ADL) scores (OR=1.259), hospital-acquired pressure ulcers (OR=1.579), and lack of ambulation recovery (OR=1.736).
- The ROC curve model demonstrated a predictive capacity for one-year mortality with an Area Under the Curve (AUC) of 0.780 (95% CI: 0.737-0.824).
Conclusions:
- Advancing age, higher comorbidity burden, functional status, development of pressure ulcers, and impaired ambulation recovery are significant independent predictors of one-year mortality in elderly hip fracture patients.
- These findings underscore the importance of early ambulation and comprehensive long-term follow-up, with a focus on frailty.
- Interventions targeting these modifiable risk factors could potentially reduce mortality rates in this vulnerable population.
Abstract:
Older adult patients with hip fractures are 3-4 times more likely to die within one-year after surgery than general population. The study aimed to identify independent predictive factors associated with one-year mortality after hip fracture surgery. A prospective prognostic cohort study was performed. All patients aged ≥65 years, consecutively admitted in three Italian hospitals with a diagnosis of fragility hip fracture were included. Patients with periprosthetic or pathological fractures were excluded. Multivariate analysis was used to determine variables that significantly increased the risk of one-year mortality and Receiver operating characteristic (ROC) curve analysis to assess their predictive capacity on the outcome.1083 patients fulfilled the inclusion criteria and the one-year follow-up was reached in 728 patients. The 16.6% of patients died within one-year after surgery. At the multivariate analysis, advancing age (OR = 1.094, 95% CI = 1.057-1.132), higher baseline Charlson Index (OR = 1.257, 95% CI = 1.114-1.418) and Activities of Daily Living scores (OR = 1.259, 95% CI = 1.143-1.388), presence of hospital-acquired pressure ulcers (PUs) (OR = 1.579, 95% CI = 1.002-2.489) and lack recovery of ambulation (OR = 1.736, 95% CI = 1.115-2.703), were found to be independent predictive factors of one-year mortality after surgery. The area under the ROC curve of the model was 0.780 (CI95% 0.737-0.824) for one-year mortality in elderly hip fractures patients. Early ambulation and careful long-term follow-up, with attention to frailty in elderly people, should be promoted.
