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Published on: August 17, 2017
Predictors of hip fracture mortality in Ghana: a single-center prospective study
Paa Kwesi Baidoo1,2, James B Odei3, Velarie Ansu4
1Directorate of Orthopedics and Trauma, Komfo Anokye Teaching Hospital, Kumasi, Ghana. pakvandal@gmail.com.
Insights
Male sex, basicervical hip fractures, low creatinine, chronic obstructive pulmonary disease (COPD), and osteoporosis significantly increase mortality risk in proximal femur fracture patients. These factors are crucial for improving patient outcomes.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Public Health
Background:
- Proximal femur fractures are a significant cause of morbidity and mortality, particularly in elderly populations.
- Identifying risk factors for mortality is crucial for improving patient management and outcomes in Ghana.
Purpose of the Study:
- To determine the key risk factors associated with mortality in patients who have sustained proximal femur fractures.
- To analyze mortality rates at various time points (1 month, 6 months, 1 year, 4 years) following hip fracture.
Main Methods:
- A 4-year prospective study involving 76 patients with proximal femur fractures in a Ghanaian hospital.
- Mortality outcomes were assessed over 4 years. Cox proportional hazards regression was used to calculate hazard ratios (HRs) for risk factors.
Main Results:
- Overall mortality at 4 years was 27.6%. Significant predictors of mortality included male sex (HR=5.24), basicervical hip fracture (HR=28.88), abnormal creatinine (HR=5.64), chronic obstructive pulmonary disease (COPD) (HR=53.45), and osteoporosis (HR=8.75).
- Higher American Society of Anesthesiologists (ASA) scores (III/IV) showed a trend towards increased mortality (p=0.08).
Conclusions:
- Male sex, basicervical hip fracture, abnormal creatinine levels, COPD, and osteoporosis are identified as major predictors of mortality in proximal femur fracture patients.
- These findings provide critical insights for clinical management strategies aimed at reducing mortality in this vulnerable patient group.
Abstract:
To determine risk factors influencing mortality in patients with proximal femur fractures in a Ghanaian hospital over a 4-year period.
Methods:
Incidence of mortality was assessed among 76 participants with proximal femur fractures from January to December 2014 and followed up for 4 years. Outcomes of interest were mortality at 1 month, 6 months, 1 year, and 4 years. Hazard ratios (HRs) were calculated using Cox proportional hazards regression, adjusting for mortality risk factors.
Results:
Among the 76 participants (mean age 75.8 years [SD = 12.02], 36 (47.4%) males), there were 21 death cases. The mean time of injury to surgery was 16.4 (SD = 16.2) days. Hip fractures comprised of 38 (50%) intertrochanteric, 35 (46.05%) transcervical, and 3 (3.95%) basicervical. Mortality at 1 month, 6 months, 1 year, and 4 years were 6.6%, 13.2%, 19.7%, and 27.6%, respectively. Multiple regression analysis showed a yearly increase in age that was associated with a 1.03-fold increase in the risk of death (p = 0.17). Comparing males to females, there was a significant difference in mortality (HR = 5.24, p = 0.03). Participants with basicervical hip fracture versus those with transcervical hip fracture were at higher risk of dying (HR = 28.88, p = 0.01). Patients with abnormal/low creatinine as compared to those with normal creatinine were at higher risk of dying (HR = 5.64, p = 0.005). Also, participants with an American Society of Anesthesiologists (ASA) score of III or IV were 2.73 times more likely to experience death than those with an ASA score of I or II (95% CI: 0.93-8.89, p = 0.08). Additionally, a higher risk of death was associated with patients with chronic obstructive pulmonary disease (COPD) (HR = 53.45, p = 0.001) and osteoporosis (HR = 8.75, p = 0.006).
Conclusion:
Being male, having basicervical hip fracture, abnormal/low creatinine, and a history of COPD and osteoporosis were the main predictors of mortality in the study population. These findings could serve as a guide when managing patients with proximal femur fractures to improve the outcome.
