Hip fracture incidence among the old and very old: A population-based study of 745,435 cases

Article (PDF Available)inAmerican Journal of Public Health 80(7):871-3 · August 1990with40 Reads
DOI: 10.1016/0022-4375(91)90022-N · Source: PubMed
Abstract
Data were obtained from the Health Care Financing Administration and the Department of Veterans Affairs (formerly called Veterans Administration) on all hospital discharges among the elderly population from 1984 through 1987 and combined with census estimates to calculate incidence rates of hip fracture for the elderly population of the United States. Rates for White women were the highest, reaching 35.4 per 1,000 per year among 95 year-olds. Comparably, White men, Black women, and Black men experienced similar age-related increases in risk, although of less magnitude and relatively less rate of change, respectively.
PUBLIC
HEALTH
BRIEFS
2.
Davis
JE:
The
future
of
major
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surgery.
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Am
1987;
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JA:
Surgery
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JE:
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JT:
DRGs
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109-111.
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S,
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M:
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RJ,
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Lagoe
RJ,
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Division
of
Health
Care
Statistics,
National
Center
for
Health
Care
Statistics:
Data
from
the
National
Hospital
Discharge
Survey,
1988.
Hip
Fracture
Incidence
among
the
Old
and
Very
Old:
A
Population-Based
Study
of
745,435
Cases
STEVEN
J.
JACOBSEN,
MS,
PHD,
JACK
GOLDBERG,
PHD,
TONI
P.
MILES,
MD,
PHD,
JACOB
A.
BRODY,
MD,
WILLIAM
STIERS,
PHD,
AND
ALFRED
A.
RIMM,
PHD
Abstract:
Data
were
obtained
from
the
Health
Care
Financing
Administration
and
the
Department
of
Veterans
Affairs
(formerly
called
Veterans
Administration)
on
all
hospital
discharges
among
the
elderly
population
from
1984
through
1987
and
combined
with
census
estimates
to
calculate
incidence
rates
of
hip
fracture
for
the
elderly
population
of
the
United
States.
Rates
for
White
women
were
the
highest,
reaching
35.4
per
1,000
per
year
among
95
year-olds.
Comparably,
White
men,
Black
women,
and
Black
men
experienced
similar
age-related
increases
in
risk,
although
of
less
magnitude
and
relatively
less
rate
of
change,
respectively.
(Am
J
Public
Health
1990;
80:871-873.)
Introduction
Hip
fractures
are
an
important
cause
of
the
morbidity
and
mortality
experienced
by
the
elderly
population
in
the
United
States.'
Despite
this,
there
have
been
relatively
few
national
population-based
studies
of
the
incidence
of
hip
fracture
in
this
country.
Of
those
previous
studies,
most
have
produced
unstable
estimates
of
incidence
rates
for
non-
Whites
(due
to
small
sample
sizes)2'3
or
the
oldest
old
(over
85
years
of
age).2-7
The
present
study
uses
newly
available
data
from
the
Health
Care
Financing
Administration
(HCFA)
and
the
Department
of
Veterans
Affairs
(VA)
to
provide
detailed
estimates
of
the
incidence
of
hip
fracture
in
the
elderly
by
age,
race,
and
sex.
Address
reprint
requests
to
Steven
J.
Jacobsen,
PhD,
Division
of
Biostatistics/Clinical
Epidemiology,
Medical
College
of
Wisconsin,
P.O.
Box
26509,
Milwaukee,
WI
53226.
This
work
was
done
while
Dr.
Jacobsen
(currently
a
third-year
medical
student
at
Medical
College
of
Wisconsin)
was
completing
the
doctoral
requirements
in
the
Epidemiology
Program,
School
of
Public
Health,
University
of
Illinois
at
Chicago.
Drs.
Goldberg
and
Miles
are
both
with
the
Epidemiology/Biostatistics
Program
there,
and
Dr.
Brody
is
Dean
of
the
School
of
Public
Health,
University
of
Illinois,
Chicago;
Dr.
Stiers
is
with
Health
Services
Research
and
Development,
VA
Hospital,
Hines,
IL;
Dr.
Rimm
is
Professor
and
Head,
Division
of
Biostatistics/Clinical
Epidemi-
ology,
Medical
College
of
Wisconsin,
Milwaukee.
This
paper,
submitted
to
the
Journal
June
19,
1989,
was
revised
and
accepted
for
publication
October
17,
1989.
©
1990
American
Journal
of
Public
Health
0090-0036/90$1.50
Methods
Data
were
obtained
from
HCFA
on
all
40
million
short-stay
hospital
discharges
for
the
calendar
years
1984
through
1987
and
4
million
discharges
from
VA
hospitals.
HCFA
requires
all
institutional
providers
to
submit
a
uniform
billing
form
that
contains
the
following
data:
age,
race,
sex,
a
maximum
of
five
ICD9-CM
diagnostic
categories,
date
of
admission
and
discharge,
and
a
unique
patient
identifier.
VA
maintains
a
similar
database,
keyed
by
the
same
patient
identifier.
Cases
of
hip
fracture
were
identified
by
scanning
the
44
million
discharge
records
for
a
discharge
diagnosis
of
fracture
of
the
hip
(ICD9-CM
820.0
through
820.9)
in
any
of
the
five
diagnostic
fields.
Patients
were
excluded
if:
1)
age
at
admis-
sion
was
less
than
65
years;
2)
the
fracture
could
have
been
attributed
to
a
neoplastic
process;
3)
the
patient
had
been
discharged
previously
for
fracture
of
the
hip
in
the
four-year
period;
4)
the
first
discharge
diagnosis
was
for
late
effects
of
fracture;
or
5)
the
patient
resided
outside
of
Puerto
Rico
or
the
United
States
proper.
The
remaining
cases
were
consid-
ered
to
be
first
fractures
of
the
hip
and
thus
comprised
the
numerator
for
the
calculation
of
rates.
Denominator
information
was
obtained
from
the
Bureau
of
the
Census
for
1985.
Incidence
rates
were
calculated
as
the
average
annual
age-,
race-,
and
sex-specific
number
of
cases
divided
by
the
population
at
risk.
Rates
were
adjusted
for
one-year
age
groups
using
the
direct
method,
with
the
entire
United
States
population
aged
65
years
and
older
serving
as
the
standard.8
Results
During
the
period
of
1984
through
1987,
810,949
hospital
discharges
for
fracture
of
the
hip
were
recorded
by
HCFA
and
11,435
were
recorded
by
VA
for
persons
over
65
years
of
age.
Of
these,
54,055
were
second
fractures
or
rehospitaliza-
tions
for
a
previous
hip
fracture.
An
additional
19,899
cases
were
persons
under
the
age
of
65
from
the
HCFA
database,
and
4,504
cases
were
discharged
for
late
effects
or
attribut-
able
to
neoplastic
processes.
The
final
number
of
eligible
incident
cases
of
first
hip
fracture
was
745,435.
(Some
cases
were
excluded
for
more
than
one
reason.)
Women
accounted
AJPH
July
1990,
Vol.
80,
No.
7
871
PUBLIC
HEALTH
BRIEFS
for
580,129
of
these
fractures
(79
percent)
whereas
men
accounted
for
only
165,306
(21
percent)
(Table
1).
The
great
majority
of
the
cases
were
among
Whites
(93
percent),
while
Blacks
and
those
of
other
or
unknown
racial
background
each
accounted
for
3
percent.
The
incidence
of
hip
fracture
among
the
elderly
for
this
time
period
was
6.63
fractures
per
1,000
per
year.
Adjusting
incidence
rates
for
age,
White
women
experienced
the
highest
incidence
rates
at
8.07
per
1,000,
followed
by
White
men
at
4.28/1,000,
Black
women
at
3.06/1,000,
and
Black
men
at
2.38/1,000.
Examining
incidence
rates
by
one
year
age
groups
(Figure
1)
shows
that
rates
for
White
women
in-
creased
exponentially
from
1.63/1,000
in
65
year-olds,
to
35.4/1,000
in
women
aged
95
years.
A
similar
exponential
pattern
of
increase
was
observed
for
White
males,
with
rates
increasing
from
0.9/1,000
for
65-year-olds
to
26.0/1,000
for
96-year-olds.
The
age-associated
increase
in
incidence
per-
sisted
in
Blacks,
but
was
less
than
exponential
in
women
and
nearly
linear
in
men.
Discussion
The
risk
of
fracture
of
the
hip
increased
with
age
well
into
the
tenth
decade
of
life
for
women
and
men,
and
Blacks
and
Whites
alike.
Incidence
rates
for
White
women
between
the
ages
of
85
and
95
were
especially
high,
with
more
than
3
percent
of
this
population
suffering
a
fracture
of
the
hip.
White
men,
Black
women,
and
Black
men
also
suffered
from
high
rates
of
injury,
with
rates
reaching
nearly
3,
2,
and
1
percent
of
the
nonagenarians,
respectively.
The
rates
for
White
men
and
women
calculated
in
this
study
resemble
those
reported
from
the
Scandinavian
countries,9-"1
except
that
rates
in
the
oldest
women
appear
to
be
higher
in
Sweden."I
Estimates
from
Rochester,
Minnesota
appear
to
underestimate
rates
for
both
men
and
women
over
TABLE
1-Demographic
Characteristics
of
Elderly
Hip
Fracture
Patients
Medicare
and
VA
Population:
1984-87
Sex
Women
N
(%)
Men
N
(%)
Total
N
(%)
All
Races
580,129
165,306
745,435
Blacks
17,143
7,809
24,952
65-74
3,424
(20.0)'
2,697
(34.5)'
6,121
(24.5)t
75-84
6,819
(39.8)
3,063
(39.2)
9,882
(39.6)
85-94
5,966
(34.8)
1,820
(23.3)
7,786
(31.2)
95+
934
(5.4)
229
(2.9)
1,163
(4.7)
Whites
544,100
151,872
695,972
65-74
103,150
(19.0)
40,323
(26.6)
143,473
(20.6)
75-84
233,140
(42.8)
64,344
(42.4)
297,484
(42.7)
85-94
189,548
(34.8)
42,978
(28.3)
232,526
(33.4)
95+
18,262
(3.4)
4,227
(2.8)
22,489
(3.2)
Other
3,740
1,801
5,541
65-74
1,131
(30.2)
548
(30.4)
1,679
(30.3)
75-84
1,319
(35.3)
725
(40.3)
2,044
(36.9)
85-94
1,118
(29.9)
473
(26.3)
1,591
(28.7)
95+
172
(4.6)
55
(3.1)
227
(5.2)
Unknown
15,146
3,824
18,970
65-74
3,375
(22.3)
1,211
(31.7)
4,586
(24.2)
75-84
6,272
(41.4)
1,766
(46.2)
8,038
(42.4)
85-94
4,560
(30.1)
736
(19.3)
5,296
(27.9)
95+
939
(6.2)
111
(2.9)
1,050
(5.5)
Percent
of
Race-
and
Sex-SpecHic
Category.
tPercent
of
Race-SpecHic
Category.
Black
Women
30
0
20
0
-"
to
10
10
65
70
75
80
85
90
95
100
Age
at
Fracture
FIGURE
1-Annual
Age-Specific
Incidence
of
Hip
Fracture
among
the
Elderly:
Population-based
Rates
by
Race
and
Sex
for
1984-87,
United
States
Lines
represent
a
smoothed
curve
based
on
the
calculated
age-,
race-,
and
sex-specific
incidence
rates.
SOURCES:
Health
Care
Financing
Administration,
Department
of
Veterans
Affairs,
US
Bureau
of
Census.
the
age
of
80
years,57
but
this
may
be
due
to
small
sample
sizes.
It
is
noteworthy
that
our
results
substantiate
prior
national
estimates
using
data
from
the
National
Hospital
Discharge
Survey
for
all
race
and
age
groups,2.4.'2
despite
the
previously
noted
problems
with
similar
data.13
There
are
several
limitations
in
these
data.
The
assump-
tion
that
all
fractures
of
the
hip
necessarily
result
in
hospi-
talization
is
probably
valid,
because
hip
fractures
are
asso-
ciated
with
a
great
deal
of
pain
and
incapacity;
but
persons
who
did
not
survive
long
enough
to
be
hospitalized
would
be
missed.
A
second
assumption
is
that
persons
hospitalized
in
this
age
range
are
covered
by
the
Medicare
insurance
program
or
cared
for
in
VA
hospitals.
According
to
the
Health
Care
Financing
Administration,'4
97
percent
of
the
United
States
population
ages
65
and
older
is
enrolled
in
the
Medicare
program.
The
number
of
cases
treated
in
VA
hospitals
appears
to
account
for
the
vast
majority
of
the
remaining
3
percent,
suggesting
these
rates
reflect
true
population
rates.
These
data
may
over-estimate
the
risk
of
an
incident
first
fracture
since
data
are
only
available
for
up
to
four
years
of
follow-up.
The
rates
presented
herein
may
represent
up
to
a
6
percent
over-estimate
of
the
risk
of
a
first
fracture.
Likewise,
the
use
of
these
data
to
estimate
the
prevalence
of
fracture
would
result
in
an
underestimate
for
the
same
reason.
The
apparent
decline
in
fracture
incidence
after
age
95
among
white
women
is
intriguing.
Possibly,
women
who
are
at
risk
of
fracture
have
been
removed
from
the
population
through
fracture-related
mortality
or
competing
causes.
It
is
noteworthy
that
this
decline
persists
when
all
fractures
during
the
four
years
of
follow-up
are
included
in
the
numerator.
Alternatively,
this
result
may
reflect
some
degree
of
non-
sampling
error
inherent
to
the
data.
Only
more
detailed
surveillance
of
an
elderly
population
will
provide
the
oppor-
tunity
to
ascertain
the
meaning
of
the
decline.
ACKNOWLEDGMENTS
The
data
were
presented
at
the
Steenbock
Symposium
on
Osteoporosis
in
Madison,
WI,
June
1989
and
the
117th
Annual
Meeting
of
the
American
Public
Health
Association,
in
Chicago,
Illinois,
October
1989.
This
work
was
completed
with
the
cooperation
of
the
Health
Care
Financing
Administration.
AJPH
July
1990,
Vol.
80,
No.
7
872
PUBLIC
HEALTH
BRIEFS
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11.
Elabdien
BS,
Olerud
S,
Karlstrom
G,
Smedby
B:
Rising
incidence
of
hip
fracture
in
Uppsala,
1965-1980.
Acta
Orthop
Scand
1984;
55:284-289.
12.
National
Center
for
Health
Statistics,
Hospital
Care
Statistics
Branch:
1987
Summary:
National
Hospital
Discharge
Survey.
Advance
Data
From
Vital
and
Health
Statistics.
No.
159.
DHHS
Pub.
No.
(PHS)
88-1250.
Hyattsville,
MD:
Public
Health
Service,
1988.
13.
Rees
JL:
Accuracy
of
hospital
activity
analysis
data
in
estimating
the
incidence
of
proximal
femoral
fracture.
Br
Med
J
1982;
284:1856-1857.
14.
Health
Care
Financing
Administration,
Bureau
of
Data
Management
and
Strategy.
Medicare
Program
Statistics:
Health
Care
Financing
Adminis-
tration:
Medicare
Enrollment,
Reimbursement,
and
Utilization,
1983.
HCFA
Pub.
No.
03234.
Baltimore,
MD:
HCFA,
1987.
Swaddling
and
Acute
Respiratory
Infections
KADRIYE
YURDAKOK,
MD,
TUNA
YAVUZ,
MD,
AND
CARL
E.
TAYLOR,
MD,
DRPH
Abstract:
In
Turkey
and
China
the
ancient
practice
of
swaddling
is
still
commonly
practiced.
Both
countries
have
extremely
high
rates
of
pneumonia,
especially
during
the
neonatal
period.
Preliminary
evidence
on
the
possibility
that
swaddling
may
interfere
with
normal
respiratory
function
and
thereby
predispose
to
pneumonia
was
gathered
in
a
teaching
health
center
in
Ankara.
Babies
who
had
been
swaddled
for
at
least
three
months
were
four
times
more
likely
to
have
developed
pneumonia
(confirmed
radiologically)
and
upper
respiratory
infections
than
babies
who
were
unswaddled.
These
preliminary
findings
were
highly
significant
and
are
being
followed
up
by
further
studies.
(Am
J
Public
Health
1990;
80:873-875.)
Introduction
The
ancient
practice
of
swaddling
has
almost
disap-
peared
in
most
countries
of
the
world.
A
national
sample
survey
in
Turkey,
however,
showed
that
93
percent
of
mothers
swaddle
their
children.'
In
China
also,
most
babies
are
tightly
swaddled
from
birth
through
the
first
several
months
of
life.2
Since
these
two
countries
include
over
one-fifth
of
the
children
of
the
world,
the
number
of
swaddled
babies
is
substantial.
In
both
countries
pneumonia
is
the
first
cause
of
death
among
children,
with
particularly
high
incidence
among
neonates.
In
Turkey
about
50,000
infant
deaths
occur
annu-
ally
due
to
pneumonia.3
In
China
over
300,000
child
deaths
per
year
are
attributed
to
pneumonia
with
a
child
mortality
rate
twice
as
high
as
the
second
highest
cause
of
death.4
Forty
percent
of
these
deaths
are
under
one
month
of
age.
Address
reprint
requests
to
Kadriye
Yurdakok,
MD,
Director
of
Child
Health,
Ministry
of
Health,
Cankaya,
Kuloglu Sokak,
6/12,
06680,
Ankara,
Turkey.
Dr.
Yavuz
is
with
the
Gulveren
Health
Center
in
Ankara;
Dr.
Taylor
is
professor
emeritus,
Johns
Hopkins
School
of
Hygiene
and
Public
Health,
Institute
for
International
Programs,
Baltimore.
This
paper,
submitted
to
the
Journal
July
5,
1989,
was
revised
and
accepted
for
publication
December
7,
1989.
©
1990
American
Journal
of
Public
Health
0090-0036/90$1.50
In
trying
to
explain
this
extremely
high
incidence
of
pneumonia
we
focused
on
the
possibility
that
swaddling
might
interfere
with
normal
respiratory
function
and
lung
expansion.
No
studies
have
been
published
of
possible
relationships
between
swaddling
and
acute
respiratory
infec-
tions
or
pneumonia.
The
common
cultural
practice
is
that
immediately
after
birth
babies
are
tightly
bound
in
layers
of
cloth.
Complete
swaddling
immobilizes
the
baby
from
the
neck
to
the
feet.
The
legs
are
pressed
firmly
together
with
the
knees
straight
and
the
arms
are
bound
to
the
sides
or
slightly
to
the
front
of
the
body.
The
layers
of
cloth are
not
only
pulled
tightly
but
they
are
also
securely
tied
to
minimize
body
movement.
In
partial
swaddling
cloth
is
wrapped
around
the
legs
and
torso
up
to
the
armpits,
but
the
arms
are
free.
In
both
types
of
swaddling
the
child
may
also
be
covered
with
netting
or
a
blanket
to
prevent
exposure
to
flies,
drafts
or
cold
air.
Babies
are
almost
always
laid
on
their
backs
and
kept
in
a
dark
room
to
induce
sleep.5
Swaddled
babies
seldom
cry
and
respira-
tions
seem
shallow
to
an
observer,
raising
the
question
of
whether
full
expansion
of
the
lungs
occurs.
A
variety
of
devices
are
used
to
dispose
of
excreta
in
Turkey
but
in
the
urban
area
where
this
study
was
done
families
use
cloth
diapers.
Methods
The
records
from
Gulveren
Health
Center
in
a
suburb
of
Ankara
were
examined
to
look
for
associations
between
swaddling
and
selected
health
problems.
This
teaching
health
center
of
Hacettepe
Medical
School
has
high
standards
of
follow-up
and
care
of
all
the
children
in
the
health
center
area.
Records
were
available
on
186
infants,
of
whom
94
had
been
unswaddled,
29
had
been
partially
swaddled,
and
63
had
been
completely
swaddled.
The
rate
of
swaddling
is
lower
than
the
national
figure
because
this
study
included
only
those
babies
who
were
swaddled
for
at
least
three
months.
All
infants
were
examined
and
detailed
histories
were
taken.
The
ages
of
the
children
at
the
time
of
this
cross-
sectional
study
ranged
from
three
to
12
months,
with
a
mean
of
6.8
months.
Sex
ratios
were
similar
in
all
groups
as
shown
AJPH
July
1990,
Vol.
80,
No.
7
873
    • "The mean age of patients with fracture of the proximal femur is high, often over 80 years, and comorbidity in this patient group is therefore frequent [13][14][15]. Women make up at least 70% of all patients with a proximal femoral fracture according to literature [16,17]. Many studies have identified predisposing factors for fracture of the proximal femur, but little is known about independent risk factors for mortality in this selected patients group [8,12,[18][19][20][21][22][23]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Fractures of the proximal femur are a significant cause of mortality and morbidity in the elderly population. Yet predictive marker of unfavourable prognosis are still lacking. Calcium phosphate product is a marker of osteo-renal dysregulation. This study investigated the role of serum calcium phosphate product (SCPP) levels as a prognostic parameter for outcome in those patients. Patients and methods: A total of 3577 consecutive patients with diagnosed fractures of the proximal femur were included in our study (72.5% females). SCPP was divided into tertiles: <1.92mmol(2)/l(2), 1.93-2.38mmol(2)/l(2) and >2.39mmol(2)/l(2). Data collection was performed prospectively and statistical evaluation was performed retrospectively. Results: Mean follow up in our study group was 11.0±0.3 months. The mean age of our study group was 79.0 years (SEM ±14 years). To facilitate analysis, patients were divided in two groups: ≤84 years (64.4%) and ≥85 years (35.6%), and mortality <12 months was 12.4% (n=445). In our study population higher SCPP levels ad admission were associated with a markedly elevated mortality. In a multivariate logistic regression model adjusted for age and sex, plasma creatinine and haemoglobin at admission caused a 1.3 (CI: 1.01-1.6) for SCPP 1.93-2.38mmol(2)/l(2), and a 1.6 (CI: 1.2-2.0) for SPP >2.39mmol(2)/l(2) fold increase in overall mortality compared to patients with baseline SCPP levels (<1.92mmol(2)/l(2)) as reference category. Conclusion: Those findings in our study population with 3577 patients over a period of 20 years proved to be, that serum Ca levels may be a good predictor for mortality in patients with fracture of the proximal femur. Further studies are required to evaluate whether these high risk patients might benefit from specific therapeutic measurements. This prognostic factor may help to increase the outcome of elderly patients with a fracture of the proximal femur.
    Article · Dec 2015
    • "The results of a worldwide study by Dhanwal et al. [58] on incidence and epidemiology of hip fractures in Asia, Africa, Europe, Latin America, North America, and Oceania show that women are more disposed to the hip fracture risk than men in different countries over the world. In the study by Jacobsen et al. [59], the age-adjusted hip fracture incidence rates in white US males and females were 4.3 and 8.1 per 1,000 per year, respectively. Higher hip fracture risk in women may be related to their lower BMD. "
    [Show abstract] [Hide abstract] ABSTRACT: Accurate assessment of hip fracture risk is very important to prevent hip fracture and to monitor the effect of a treatment. A subject-specific QCT-based finite element model was constructed to assess hip fracture risk at the critical locations of femur during the single-leg stance and the sideways fall. The aim of this study was to improve the prediction of hip fracture risk by introducing a novel failure criterion to more accurately describe bone failure mechanism. Hip fracture risk index was defined using cross-section strain energy, which is able to integrate information of stresses, strains, and material properties affecting bone failure. It was found that the femoral neck and the intertrochanteric region have higher fracture risk than other parts of the femur, probably owing to the larger content of cancellous bone in these regions. The study results also suggested that women are more prone to hip fracture than men. The findings in this study have a good agreement with those clinical observations reported in the literature. The proposed hip fracture risk index based on strain energy has the potential of more accurate assessment of hip fracture risk. However, experimental validation should be conducted before its clinical applications.
    Full-text · Article · Nov 2015
    • "Geriatric hip fractures are a major public health concern affecting 2–4% of men and 3–9% of women >65 years old annually with an estimated lifetime risk of 5% and 16%, respectively678. One year mortality rates approach 35% with additional loss of functional ability67891011. Optimal management of geriatric hip fracture patients with AS is a growing clinical need. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Aortic stenosis (AS) is an established predictor of perioperative complications following both cardiac and non-cardiac surgery. The purpose of this study was to evaluate the risk of mortality and perioperative complications among surgically treated hip fractures in elderly patients with moderate or severe AS compared to those without AS (negative controls). Materials and methods: A retrospective case-controlled review (1:2) of elderly (≥65 years) surgically treated hip fractures from 2011 to 2015 with moderate/severe AS (according to American Heart Association criteria) was conducted. Postoperative complication rates, 30 days and 1 year mortality were reviewed. Results: Moderate/severe AS was identified in 65 hip fracture cases and compared to 129 negative controls. AS cases were significantly older with higher rates of coronary artery disease and atrial fibrillation (p<0.05). Rates of any 30-day perioperative complication (74% vs. 37%, p<0.001) and severe non-cardiac 30-day perioperative complication (52% vs. 26%, p=0.002) were significantly higher among AS cases compared to controls. Kaplan Meier estimates of 30-day mortality (14.7% vs. 4.2%, p<0.001) and 1-year mortality (46.8% vs. 14.1%, p<0.001) were significantly higher in AS cases compared to controls. Multivariate analysis of severe 30-day postoperative complications identified moderate/severe AS (OR 4.02, p=0.001), pulmonary disease (OR 7.36, p=0.002) and renal disease (OR 3.27, p=0.04) as independent predictors. Moderate/severe AS (OR 3.38, p=0.03), atrial fibrillation (OR 3.73, p=0.03) and renal disease (OR 4.44, p=0.02) were independent predictors of 30-day mortality. Moderate/severe AS (OR 5.79, p<0.001) and renal disease (OR 3.39, p=0.02) were independent predictors of 1-year mortality. Conclusion: Aortic stenosis is associated with a significantly increased risk of perioperative complications, 30-day mortality and 1-year mortality in elderly patients undergoing surgical treatment of hip fractures.
    Full-text · Article · Oct 2015
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