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Pathologic Versus Native Hip Fractures: Comparing 30-day Mortality and Short-term Complication Profiles
Troy B Amen1, Nathan H Varady1, Brett L Hayden1
1Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
The Journal of Arthroplasty
|January 29, 2020
Summary
Patients with pathologic hip fractures face higher mortality and complication rates after surgery compared to those with native hip fractures. Existing treatment guidelines for native fractures may not be suitable for pathologic cases, necessitating tailored care strategies.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Patient Outcomes
Background:
- Extensive research exists for native hip fractures, leading to evidence-based guidelines.
- Data on pathologic hip fractures is limited, and guideline generalizability remains unclear.
Purpose of the Study:
- To compare mortality rates and complication profiles between patients with pathologic and native hip fractures.
Main Methods:
- Utilized the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database (2007-2017).
- Identified and matched 2601 pairs of patients with pathologic and native hip fractures using propensity scoring.
- Compared 30-day postoperative complications and mortality rates using McNemar's test, controlling for baseline covariates.
Main Results:
- Pathologic hip fracture patients had significantly higher rates of death (6.3% vs. 4.3%), serious adverse events (17.3% vs. 13.5%), and minor complications (34.3% vs. 29.1%).
- Higher rates of extended postoperative length of stay (30.2% vs. 25.9%), readmissions (11.9% vs. 8.4%), and thromboembolic complications (3.0% vs. 1.6%) were observed in the pathologic group.
- Pathologic fracture patients also required more perioperative transfusions (31.5% vs. 26.4%).
Conclusions:
- Pathologic hip fractures are associated with significantly higher postsurgical complication rates than native hip fractures.
- Current guidelines for native hip fractures may not be generalizable to patients with pathologic fractures.
- Orthopedic surgeons should implement vigilant monitoring for deep vein thrombosis, employ blood-sparing techniques, and utilize multidisciplinary approaches for managing these complex cases.
