Risk factors for mortality in delayed intertrochanteric fractures

We aimed to figured out the risk factors of one year mortality in intertrochanteric hip fractures with delayed operation more than 72 hours. 96 out of 226 patients with proximal femoral fracture included in this study. Hemogram, blood urine nitrogen (BUN), creatinine, sodium, potassium and serum albumin levels are recorded from their blood test at administration of hospital. Time to theatre and postoperative needs for intensive care are recorded. Mobility functions before fracture and after 3 months of operation are assessed by mobility part of Barthel index. Multiple logistic regression analysis was performed to estimate the simultaneous effects of important covariates. In univariate model, age(p=0.0027), ASA(p=0.00), loss of mobility(p=0.00), bone union time(p=0.001), blood transfusion(p=0.026), albumin(p=0.004) and mobility after operation (p=0.001) were associated with mortality but in the final model for multivariate regression analysis loss of mobility level (p=0.001) and bone union time (p=0.02) were found to be independent risk factors of mortality. In postoperative period mobilization is the most important variable that we could changed in intertrochanteric fractures to decrease mortality. Whatever the timing of operation, gaining the mobility as soon as possible should be the goal of our treatment

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1. Beaupre LA, Jones CA, Saunders LD, Johnston DW, Buckingham J, Majumdar SR. Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med. 2005;20(11):1019-25.

2. Wilkins K. Health care consequences of falls for seniors. Health Rep. 1999;10(4):47-55.

3. Karres J, Heesakkers NA, Ultee JM, Vrouenraets BC. Predicting 30- day mortality following hip fracture surgery: evaluation of six risk prediction models. Injury. 2015;46(2):371-7.

4. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, metaanalysis, and meta-regression. Can J Anaesth. 2008;55(3):146-54.

5. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609-16.

6. Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury. 2012;43(6):676-85.

7. Owens WD, Felts JA, Spitznagel EL, Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49(4):239-43.

8. Mahoney FI, Barthel D. Functional evaluation: The Barthel Index. Md Med J. 1965;14:56-61.

9. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-33.

10. Nguyen ND, Eisman JA, Center JR, Nguyen TV. Risk factors for fracture in nonosteoporotic men and women. J Clin Endocrinol Metab. 2007;92(3):955-62.

11. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD. Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma. 1997;11(3):162-5.

12. Yonezawa T, Yamazaki K, Atsumi T, Obara S. Influence of the timing of surgery on mortality and activity of hip fracture in elderly patients. J Orthop Sci. 2009;14(5):566-73.

13. Hommel A, Ulander K, Bjorkelund KB, Norrman PO, Wingstrand H, Thorngren KG. Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury. 2008;39(10):1164-74.

14. Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br. 2009;91(7):922-7.

15. Smektala R, Endres HG, Dasch B, Maier C, Trampisch HJ, Bonnaire F, Pientka L. The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord. 2008;9:171.

16. Karaman O, Ozkazanli G, Orak MM, Mutlu S, Mutlu H, Çalışkan G, Karakuş Ö, Saygı B. Factors affecting postoperative mortality in patients older than 65 years undergoing surgery for hip fracture. Ulus Travma Acil Cerrahi Derg. 2015;21(1):44-50.

17. Donegan DJ, Gay AN, Baldwin K, Morales EE, Esterhai JL, Jr. Mehta S. Use of medical comorbidities to predict complications after hip fracture surgery in the elderly. J Bone Joint Surg Am.. 2010;92(4):807-13.

18. Mathias Mosfeldt, Ole B Pedersen, Troels Riis, Worm HO, Mark Sv, Jørgensen HL, Duus BR, Lauritzen JB. Value of routine blood tests for prediction of mortality risk in hip fracture patients. Acta Orthop. 2012;83(1):31–5.

19. Seyedi HR, Mahdian M, Khosravi G, Bidgoli MS1, Mousavi SG1, Razavizadeh MR1, Mahdian S1, Mohammadzadeh M. Prediction of mortality in hip fracture patients: role of routine blood tests. Arch Bone Jt Surg. 2015;3(1):51-5.

20. Gruson KI, Aharonoff GB, Egol KA, Zuckerman JD, Koval KJ. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma. 2002;16(1):39-44.

21. Carson JL, Duff A, Berlin JA, Lawrence VA, Poses RM, Huber EC, O'Hara DA, Noveck H, Strom BL. Perioperative blood transfusion and postoperative mortality. Jama. 1998;279(3):199-205.

22. Johnston P, Wynn-Jones H, Chakravarty D, Boyle A, Parker MJ. Is perioperative blood transfusion a risk factor for mortality or infection after hip fracture? J Orthop Trauma. 2006;20(10):675-9.

23. Lahtinen A, Leppilahti J, Harmainen S, Sipilä J, Antikainen R, Seppänen ML, Willig R, Vähänikkilä H, Ristiniemi J, Rissanen P, Jalovaara P. Geriatric and physically oriented rehabilitation improves the ability of independent living and physical rehabilitation reduces mortality: A randomised comparison of 538 patients. Clin Rehabil. 2015;29(9):892-906

24. Roder F, Schwab M, Aleker T, Morike K, Thon KP, Klotz U. Proximal femur fracture in older patients--rehabilitation and clinical outcome. Age Ageing. 2003;32(1):74-80.

25. Sener M, Onar V, Kazlmoglu C, Yagdi S. Mortality and morbidity in elderly patients who underwent partial prosthesis replacement for proximal femoral fractures. Eklem hastaliklari ve cerrahisi = Joint diseases & related surgery. 2009;20(1):11-7.

26. Handoll HH, Sherrington C, Mak JC. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database Syst Rev. 2011;16;(3):CD001704.

27. Cameron ID, Handoll HH, Finnegan TP, Madhok R, Langhorne P. Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures. Cochrane Database Syst Rev. 2001(3):CD000106.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: 4
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )
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