Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int

Department of Internal Medicine and Endocrinology, Copenhagen University Hospital Gentofte, Niels Andersensvej 65, 2900, Hellerup, Denmark.
Osteoporosis International (Impact Factor: 4.17). 06/2009; 20(10):1633-50. DOI: 10.1007/s00198-009-0920-3
Source: PubMed


This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlighting the need for interventions to reduce this risk.Patients experiencing hip fracture after low-impact trauma are at considerable risk for subsequent osteoporotic fractures and premature death. We conducted a systematic review of the literature to identify all studies that reported unadjusted and excess mortality rates for hip fracture. Although a lack of consistent study design precluded any formal meta-analysis or pooled analysis of the data, we have shown that hip fracture is associated with excess mortality (over and above mortality rates in nonhip fracture/community control populations) during the first year after fracture ranging from 8.4% to 36%. In the identified studies, individuals experienced an increased relative risk for mortality following hip fracture that was at least double that for the age-matched control population, became less pronounced with advancing age, was higher among men than women regardless of age, was highest in the days and weeks following the index fracture, and remained elevated for months and perhaps even years following the index fracture. These observations show that patients are at increased risk for premature death for many years after a fragility-related hip fracture and highlight the need to identify those patients who are candidates for interventions to reduce their risk.

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    • "Medical records were scrutinised for general complications during the first six months and for local complications during the first year after surgery. The shorter time frame for general complications was chosen to identify events with a plausible relation to the hip fracture, in combination with the known increased risk of death during the first six months post fracture [11]. Only complications leading to contact with the hospital were registered; i.e. simple falls or complications treated by general practitioners were not included. "
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    ABSTRACT: The aim of every patient with hip fracture is to regain previous function but we know little about the outcome, especially patient-reported outcome. We wanted to investigate what factors influence the result one year after hip fracture, including fast-track for hip fracture patients, as well as investigating the patients' satisfaction with their rehabilitation and to what degree they regained their pre-fracture function. All patients (>20 years, non-pathological fracture, residents in the catchment area, n=664) having surgery for hip fracture at our hospital during 2011 were included in a retrospective cohort study. From medical records, information was gathered about pre-fracture condition as well as fracture type, surgical details, length of stay and whether the patient entered the hospital through the fast-track system. Medical records were scrutinised for general complications up to six months and for local complications up to one year after surgery. A postal questionnaire was sent one year after surgery inquiring about health status, pain and satisfaction along with multiple-choice questions regarding mobility and rehabilitation. Variables were analysed with linear regression or the proportional odds model. The most common general complications were new falls, pneumonia and new fractures. Deep infection was the most frequent local complication. The only significant effect of the fast-track system was shorter time to surgery (78 vs. 62% had surgery within 24h, p<0.001). A total of 29% reported to have regained their previous mobility and 30% considered the rehabilitation to be adequate. Mean value for pain VAS was 24 (SD 22) and for satisfaction 28 (SD 25). Absence of general and local complications correlated to satisfaction and hip pain. General complications correlated to loss of function. Higher age correlated to inadequate rehabilitation. General complications seem to be the major risk factor, being the only factor affecting functional outcome and together with local complications affecting pain and satisfaction. To avoid general complications, co-operation between orthopaedic surgeons and internists may be crucial in the aftercare of hip fracture patients. A majority did not receive adequate rehabilitation and efforts need to be made to improve the rehabilitation process. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Injury 07/2015; 320. DOI:10.1016/j.injury.2015.07.024 · 2.14 Impact Factor
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    • "Hip fractures are associated with increased mortality in both women and men (Roberts and Goldacre 2003, Haleem et al. 2008, Abrahamsen et al. 2009, Hindmarsh et al. 2009, Haentjens et al. 2010, Mundi et al. 2014), as are osteoporotic vertebral fractures (van Staa et al. 2001, O'Neill and Roy 2005, Harris et al. 2010). The influence of upper extremity fracture on mortality is far less studied, and the findings reported have been inconsistent. "
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    ABSTRACT: Background and purpose — Increased mortality after hip fracture is well documented. The mortality after hospitalization for upper extremity fracture is unknown, even though these are common injuries. Here we determined mortality after hospitalization for upper extremity fracture in patients aged ≥16 years. Patients and methods — We collected data about the diagnosis code (ICD10), procedure code (NOMESCO), and 7 additional characteristics of 5,985 patients admitted to the trauma ward of Central Finland Hospital between 2002 and 2008. During the study, 929 women and 753 men sustained an upper extremity fracture. The patients were followed up until the end of 2012. Mortality rates were calculated using data on the population at risk. Results — By the end of follow-up (mean duration 6 years), 179 women (19%) and 105 men (14%) had died. The standardized mortality ratio (SMR) for all patients was 1.5 (95% CI: 1.4–1.7). The SMR was higher for men (2.1, CI: 1.7–2.5) than for women (1.3, CI: 1.1–1.5) (p < 0.001). The SMR decreased with advancing age, and the mortality rate was highest for men with humerus fractures. Interpretation — In men, the risk of death related to proximal humerus fracture was even higher than that reported previously for hip fracture. Compared to the general population, the SMR was double for humerus fracture patients, whereas wrist fracture had no effect on mortality.
    Acta Orthopaedica 04/2015; 86(5):1-5. DOI:10.3109/17453674.2015.1043833 · 2.77 Impact Factor
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    • "Males had higher relative mortality than females. Several studies reported in a 2008 review confirm that this higher mortality diminishes in older patients [8]. Although age-standardised death rates in this study tended to be higher for men for at least 4 years, we could not confirm that the degree of excess mortality was greater for men. "
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    ABSTRACT: One-year mortality after hip fracture may exceed 30% with a very large number of reported risk factors. Determinants of mortality beyond 1 year are rarely described. This study employs multiple data linkages to examine mortality rates, risk factor profiles and age-specific excess mortality at intervals from 30 days to 4 years. Retrospective cohort study of linked administrative datasets describing hospital episodes, residential aged care (RAC) admissions and date of death for 2552 Australian veterans and war widows hospitalised for hip fracture in 2008-09. Associations between time to death and patient age, sex, pre-fracture accommodation, fracture type, treatment options, selected comorbidities and complications were tested in Cox proportional hazards models. In a population with mean age of 86.6 years (range 54-100 years), overall death rate was 11% at 30 days, 34% at 1 year, 47% at 2 years and 67% after 4 years. For males hospitalised from RAC 1-year mortality was 72%, contrasting with 19% for females from the community. Risk of death within 1 year was increased by male sex, increasing age, pre-fracture RAC residency, transfer to intensive care and coexistent cancer, cardiac and renal failure, cerebrovascular disease and pressure ulcers. Patients selected for rehabilitation had lower mortality rates. Patterns of determinants for mortality changed over time. Above-expected age-specific mortality was sustained for 4 years except for males 90 years and older. Pre-fracture RAC residence was the strongest determinant factor for mortality. Patients selected for rehabilitation had lower mortality rates. The profiles of explanatory variables for death altered with increasing time from the index fracture event. Copyright © 2015. Published by Elsevier Ltd.
    Injury 03/2015; 307(6). DOI:10.1016/j.injury.2015.03.006 · 2.14 Impact Factor
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