Risk factors for in-hospital post-hip fracture mortality

• Published in: Bone (New York, N.Y.) N.Y.), 2011-09, Vol.49 (3), p.553-558
• Main Authors: Frost, Steven A, Nguyen, Nguyen D, Black, Deborah A, Eisman, John A, Nguyen, Tuan V
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Australia; Biological and medical sciences; Comorbidity; Female; Fundamental and applied biological sciences. Psychology; Heart Failure - complications; Heart Failure - epidemiology; Hip Fractures - epidemiology; Hip Fractures - mortality; Hospital Mortality; Humans; Injuries of the limb. Injuries of the spine; Length of Stay; Liver Diseases - complications; Liver Diseases - epidemiology; Male; Medical sciences; Middle Aged; Models, Theoretical; Orthopedics; Prognosis; Risk Factors; Traumas. Diseases due to physical agents; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 8756-3282; 1873-2763
• DOI: 10.1016/j.bone.2011.06.002

Abstract Introduction Approximately 10% of hip fracture patients die during hospitalization; however, it is not clear what risk factors contribute to the excess mortality. This study sought to examine risk factors of, and to develop prognostic model for, predicting in-hospital mortality among hip fracture patients. Methods We studied outcomes among 410 men and 1094 women with a hip fracture who were admitted to a major-teaching-hospital in Sydney (Australia) between 1997 and 2007. Clinical data, including concomitant illnesses, were obtained from inpatient data. The primary outcome of the study was in-hospital mortality regardless of length of stay. A Log-binomial regression model was used to identify risk factors for in-hospital mortality. Using the identified risk factors, prognostic nomograms were developed for predicting short term risk of mortality for an individual. Results The median duration of hospitalization was 9 days. During hospitalization, the risk of mortality was higher in men (9%) than in women (4%). After adjusting for multiple risk factors, increased risk of in-hospital mortality was associated with advancing age (rate ratio [RR] for each 10-year increase in age: 1.91 95% confidence interval [CI]: 1.47 to 2.49), in men (RR 2.13; 95% CI 1.41 to 3.22), and the presence of comorbid conditions on admission (RR for one or more comorbid conditions vs. none: 2.30; 95% CI 1.52 to 3.48). Specifically, the risk of mortality was increased in patients with a pre-existing congestive heart failure (RR 3.02; 95% CI: 1.65 to 5.54), and liver disease (RR 4.75; 95% CI: 1.87 to 12.1). These factors collectively accounted for 69% of the risk for in-hospital mortality. A nomogram was developed from these risk factors to individualize the risk of in-hospital death following a hip fracture. The area under the receiver operating characteristic curve of the final model containing age, sex and comorbid conditions was 0.76. Conclusion These data suggest that among hip fracture patients, advancing age, gender (men), and pre-existing concomitant diseases such as congestive heart failure and liver disease were the main risk factors for in-hospital mortality. The nomogram developed from this study can be used to convey useful prognostic information to help guide treatment decisions.