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Predictors of short-term outcomes after postoperative periprosthetic femoral fracture : a UK linked data analysis
Mohammad Aryaie1, Jonathan T Evans2, Cliff L Shelton3,4
1Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK.
Insights
Patient factors like age and comorbidities predict outcomes for postoperative periprosthetic femoral fractures (POPFFs). No hospital factors were associated with adverse outcomes in this study of POPFF patients.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Geriatric Medicine
Background:
- Postoperative periprosthetic femoral fractures (POPFFs) following hip and knee arthroplasty are a growing concern with significant morbidity.
- Understanding predictors of POPFF outcomes is crucial for improving patient care and resource allocation.
Purpose of the Study:
- To identify patient and hospital-level factors associated with adverse short-term outcomes after POPFF.
- To inform clinical practice and health policy regarding POPFF management.
Main Methods:
- Retrospective analysis of administrative hospital data for POPFF admissions in England (April 2016 - December 2022).
- Inclusion of demographic data, comorbidities, admission source, and pre-POPFF healthcare utilization.
- Multilevel models used to predict in-hospital death, 30-day mortality, prolonged length of stay (LOS), and 30-day emergency readmission.
Main Results:
- Older age, congestive heart failure, liver disease, and admission from a care home were associated with higher mortality and/or longer LOS.
- Female patients had lower mortality and readmission rates.
- Surgical fixation or revision for POPFF was linked to lower 30-day mortality but longer hospital stays.
- Previous hip fracture and prior emergency admissions predicted readmission and longer LOS.
- No association found between hospital-level National Hip Fracture Database KPIs or POPFF admission volume and patient outcomes.
Conclusions:
- Patient-specific factors, including age, comorbidities, and prior healthcare interactions, are key predictors of adverse outcomes following POPFF.
- Hospital-level performance indicators and admission volume did not significantly influence short-term POPFF outcomes in this cohort.
- Future research should focus on optimizing patient-level risk stratification and management strategies for POPFF.
Aims:
Postoperative periprosthetic femoral fractures (POPFFs) following hip and knee arthroplasty are increasing. They often have poor outcomes. We have limited understanding of the predictors of these outcomes, which this study addresses.
Methods:
We extracted administrative hospital data for patients aged 18 years and above with admissions to NHS hospitals in England with a primary diagnosis of POPFF between April 2016 and December 2022, including demographic characteristics, comorbidities, surgery for POPFF, admission source, outpatient department (OPD) appointments, and pre-POPFF admissions. Data were linked to the national death register. The most relevant available hospital-level key performance indicators (KPIs) were taken from the National Hip Fracture Database (NHFD). We used multilevel models with random intercepts for hospitals to predict in-hospital death, 30-day death, length of stay (LOS) above the upper quartile, and 30-day emergency readmission.
Results:
A total of 33,728 patients were included, with a median age of 82 years (IQR 73 to 88); 65.9% were female. In total, 1,510 deaths occurred within 30 days of admission. In multiple regression models, age was associated with higher mortality and longer LOS. Females showed lower odds of mortality and 30-day readmission. Congestive heart failure and liver disease were more strongly linked to all adverse outcomes than were other comorbidities. Fixation (odds ratio (OR) 0.72, 95% CI 0.64 to 0.81) and revision (OR 0.78, 95% CI 0.68 to 0.91) were associated with lower 30-day mortality but longer hospital stays than having neither procedure. Previous hip fracture was associated with 30-day readmission and longer LOS but not with mortality. Admission from a care home was associated with higher 30-day mortality (OR 1.70, 95% CI 1.31 to 2.39), but shorter LOS. Previous any-cause emergency admissions and missed outpatient appointments were associated with worse outcomes. Hospital-level NHFD KPIs for POPFF and admission numbers for POPFF were not associated with any outcome.
Conclusion:
We identified several patient factors, but no hospital factors, associated with adverse short-term outcomes following POPFF admission.
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