Elevated 1-Year Mortality Rate in Males Sustaining Low-Energy Proximal Femur Fractures and Subgroup Analysis Utilizing Age-Adjusted Charlson Comorbidity Index
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Published on: August 17, 2017
Kyle A Schultz1, Benjamin A Westcott1, Kimberly R Barber2
1Department of Orthopedics, Ascension Genesys Hospital, Grand Blanc, MI, USA.
Insights
Men with low-energy femur fractures face higher mortality risk than women. This is linked to poorer overall health status (age-adjusted Charlson comorbidity index) in men, impacting recovery from these common fractures.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Public Health
Background:
- Low-energy proximal femur fractures are a significant health concern in the aging population.
- Identifying patients at increased mortality risk is crucial for surgical decision-making.
- Gender disparities in mortality following these fractures require investigation.
Purpose of the Study:
- To evaluate gender differences in 1-year mortality after low-energy proximal femur fractures.
- To analyze the impact of fracture location, age, and comorbidities on mortality.
- To identify specific subgroups of patients at higher risk.
Main Methods:
- Retrospective analysis of patients ≥40 years with proximal femur fractures (2014-2017).
- Comorbidities identified using ICD-9/10 codes for age-adjusted Charlson comorbidity index (ACCI) calculation.
- Mortality within 1 year of injury determined via county clerk database; statistical comparisons between genders performed.
Main Results:
- Women sustained fractures at nearly 3:1 ratio to men.
- Men presented with a significantly higher ACCI (5.35 vs 4.86).
- Men had increased 1-year mortality for all fractures (31.3% vs 21.5%) and intertrochanteric fractures (36.2% vs 22.9%).
Conclusions:
- Men with low-energy femur fractures exhibit a higher mortality risk compared to women.
- Men's poorer baseline health status (higher ACCI) may contribute to increased fracture risk and impaired recovery.
- Findings emphasize the need for tailored risk assessment and management strategies for male patients.
Introduction:
Low-energy proximal femur fractures are common in the aging population and the ability to identify patients at increased mortality risk provides surgeons information to improve informed decision-making with patients and families. We evaluated for gender differences in 1-year mortality after sustaining low-energy proximal femur fractures with subgroup analysis to identify the impact of fracture location, age, and comorbidities on mortality.
Materials And Methods:
Patients ≥40 years of age sustaining a low-energy proximal femur fracture identified at our institution between January 1, 2014, and December 31, 2017. International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes were used to identify comorbidities for calculation of the age-adjusted Charlson comorbidity index (ACCI). The county clerk database was searched to identify mortality within 1 year of injury. One-year mortality rates were calculated and multiple comparisons were made between genders controlling for age, fracture location, and/or ACCI.
Results:
Women presented with low-energy proximal femur fractures at a rate of almost 3:1 to men at our institution (P = .001). Men demonstrated a significantly increased ACCI at presentation (5.35 ± 2.55 vs 4.86 ± 1.77, P = .03). Men had an increased 1-year mortality rate for all (31.3% vs 21.5%, P = .004) and intertrochanteric (IT) fractures (36.2% vs 22.9%, P = .008). Controlling for ACCI, gender, and fracture location, men demonstrated increased mortality rate with IT fractures (P = .002) and trended toward but did not reach significance with femoral neck fractures (P = .07).
Discussion:
Men presenting with low-energy femur fractures are at an increased mortality risk compared to women. On average, men present with an overall worse health status as identified by ACCI, which could predispose these patients not only to fractures themselves but also impair their ability to recover from injury.
Conclusion:
Men are at an increased 1-year mortality risk after sustaining proximal femur fractures.
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