Abstract:

BACKGROUND: Up to now, the research on the mortality rate of hip fracture after operation mainly focuses on 30 days to 1 year and longer. However, there are few studies on early postoperative mortality of hip fracture. 

OBJECTIVE: To compare the differences between survived and dead patients at 72 hours after surgery, and to explore the risk factors associated with 72-hour postoperative mortality in hip fracture patients.

METHODS: Clinical data of 2 811 hip fracture patients admitted to Zhujiang Hospital of Southern Medical University from January 2013 to December 2018 were retrospectively analyzed, including surgical treatment and conservative treatment. The patient’s age ranged from 15 to 101 years old. This study compared the differences between the survival group and death group within 72 hours after surgery. According to the outcome, the patients were divided into survival group and death group. The patient’s medical records were collected, including gender, age, preoperative ASA classification, preoperative walking ability score, preoperative cognitive level, whether to take anticoagulants orally, fracture classification, operation mode, internal plant species, operation time, blood transfusion volume, anesthesia mode, and postoperative complications. The diagnosis of each observation factor was based on the clinical diagnosis of medical records. The survival status, cause of death, intraoperative and postoperative complications were recorded within 72 hours after operation. The patients were followed up by telephone within half a year after operation.

RESULTS AND CONCLUSION: (1) Forty-seven patients received conservative treatment, and 1 patient died 24 hours after admission; totally 2 764 patients were included in the study. (2) The average age was 72.5 years, including 2 035 females and 729 males. The mortality rate within 72 hours after operation was about 0.90% (25 patients). (3) In the 72-hour postoperatively death group, the proportion of patients with advanced age, ASA grade 3 or above, pre-traumatic walking ability limitation and cognitive impairment was higher (P < 0.05). (4) In the 72-hour survival group, more patients received surgical treatment within 48 hours of injury (P < 0.05). (5) The incidence of implant-related complications was higher in the death group than in the survival group, but the difference between the two groups was not statistically significant (P > 0.05). (6) In conclusion, great attention has been paid to the optimization of the management of patients undergoing hip fracture surgery and its concomitant effect on survival. Our study found that the increased risk of death within 72 hours after hip fracture surgery is associated with advanced age, ASA grade 3 or above, limited walking ability before injury, cognitive impairment and more than 48 hours after injury; however, it is not related to the type of implant of the patient. The information provided in this study can be used to assess patients with the highest risk of death within 72 hours after surgery. On the basis of this study, it may be necessary to further collect multi-center, more detailed data to assess the impact of various factors on the postoperative mortality of hip fracture patients, and to identify high-risk factors affecting the early postoperative mortality.

Key words: hip fracture, mortality, early postoperative mortality, perioperative period, risk factor