85.
Admission to hospital in the months before a fractured hip is
associated with increased mortality
Christian Medom Madsen, Henrik Løvendahl Jørgensen, Troels Riis, Susanne
van der Mark, Jes Bruun Lauritzen, Benn Duus
Department of Orthopaedic Surgery Bispebjerg University Hospital;
Department of Clinical Biochemistry, Bispebjerg University Hospital;
Department of Orthopaedic Surgery, Bispebjerg University Hospital;
Department of Orthopaedic Surgery, Bispebjerg University Hospital;
Department of Orthopaedic Surgery, Bispebjerg University Hospital;
Department of Orthopaedic Surgery, Bispebjerg University Hospital
Background:
In elderly and frail hip fracture patients it is reasonable to view
the fracture not only as a cause of poor outcome, but in some also as a
symptom of declining health. Several factors have been associated with poor
outcomes in this group of patients. We hypothesized that hospital admissions
in the period leading up to the fracture could be as well.
Purpose / Aim of Study:
To investigate the relationship between hospital
admissions in the 6 months prior to the hip fracture and the outcome following
the fracture.
Materials and Methods:
The study population consisted of 522 consecutive
patients (>75 years) from our hip fracture database. Information in the
database has been gathered using a standardized hip fracture chart and through
chart review. Information on hospital admissions was retrieved from the
discharge registries of Bispebjerg and Frederiksberg Hospital.
Findings / Results:
25.1% (131/522)
of the patients had one or more
admissions to the hospitals listed above in the 6 months preceding their
fracture. In the univariate analyses, hospital admission prior to the fracture was
significantly associated with increased mortality at 90 days (21.5% vs 33.6%,
p=0.005) and at 1 year ( 33.5% vs 45.8%, p=0.011), but not at 30 days ( 13.0%
vs 15.3%, p=0.5). In the multivariate analyses including the variables age,
gender, residence, ASA-score and type of fracture, hospital admission prior to
the fracture was still significantly associated with mortality after 90 days (HR
1.57 [1.06- 2.33])
and 1 year (HR 1.46 [1.05- 2.02]), but not after 30 days (HR
1.14 [0.66-2.00]).
Conclusions:
Admissions to hospital in the six months prior to a hip fracture
is associated with poor outcomes following the fracture in the form of
increased rates of mortality after 90 days and at 1-year. Thus the pre- fracture
health status is associated with post-fracture mortality.
