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Hyperchloremia at hospital admission for hip fractures is associated with increased morbidity and mortality rates
Serhat Gürbüz1, Olcayto Ocak2, Mustafa Cağlar Kır3
1Department of Orthopedics and Traumatology, Health Sciences University, Metin Sabancı Baltalimanı Bone Diseases Training and Research Center, İstanbul-Türkiye.
Insights
Elderly hip fracture patients with high initial serum chloride levels experienced longer hospital stays. Elevated chloride may indicate increased hospitalization risk in this population.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Emergency Medicine
- Clinical Chemistry
Background:
- Hip fractures in the elderly are a significant public health issue, leading to high morbidity, mortality, and healthcare costs.
- Initial serum chloride levels upon emergency department admission are investigated as a potential predictor of outcomes in elderly hip fracture patients.
Purpose of the Study:
- To determine the impact of initial serum chloride levels on hospital length of stay, revision surgeries, and in-hospital mortality in elderly patients with hip fractures.
Main Methods:
- A cohort of 204 elderly patients (≥65 years) with hip fractures admitted to the emergency department between August 2022 and August 2023.
- Patients were classified into normochloremic (96-108 mEq/L) and hyperchloremic (>115 mEq/L) groups based on initial serum chloride levels.
- Comparison of length of hospital stay and postoperative complications between the two groups.
Main Results:
- The hyperchloremic group had a significantly longer average hospital stay (15.5 days) compared to the normochloremic group (9.9 days) (p=0.009).
- No statistically significant differences were observed in mortality or revision surgery rates between the groups.
- All six in-hospital deaths occurred in patients with initial serum chloride levels above 115 mEq/L.
Conclusions:
- Elevated serum chloride levels at admission are associated with prolonged hospital stays in elderly hip fracture patients.
- Hyperchloremia may serve as a prognostic marker for extended hospitalization, suggesting increased morbidity risk in this population.
- Further research is needed to explore the direct predictive value of hyperchloremia on mortality and revision surgery.
Background:
Hip fractures in the elderly represent a major public health concern due to their high incidence, associated morbidity and mortality, and rising healthcare costs. This study investigates the impact of initial serum chloride levels, measured upon emergency department admission, on hospital length of stay, revision surgeries, and in-hospital mortality in elderly patients with hip fractures.
Methods:
Between August 2022 and August 2023, a total of 204 patients over 65 years of age diagnosed with hip fractures in the emergency department were included in the study. Patients were categorized into two groups based on their initial serum chloride levels: normochloremic (96-108 mEq/L) and hyperchloremic (>115 mEq/L). Length of hospital stay and postoperative complications were compared between the groups.
Results:
The mean chloride level was 102.1 mEq/L in the normochloremic group and 121.3 mEq/L in the hyperchloremic group. The average hospital length of stay was 9.9 days in the normochloremic group and 15.5 days in the hyperchloremic group, a statistically significant difference (p=0.009). Mortality and revision surgery rates did not show statistically significant differences between the groups. However, all six patients who died during the study had serum chloride levels above 115 mEq/L at admission.
Conclusion:
This study demonstrates that elevated serum chloride levels at admission are associated with prolonged hospital stays and increased morbidity in elderly patients with hip fractures. While hyperchloremia may not directly predict mortality or the need for revision surgery, it may serve as a prognostic marker for extended hospitalization, indicating a higher risk in this vulnerable population.
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