A Review of Hip Fracture Mortality—Why and How Does Such a Large Proportion of These Elderly Patients Die?

Aodhnait S.  Fahy; Fabian  Wong; Kumarapathan  Kunasingam; Daniel  Neen; Frances  Dockery; Adil  Ajuied; Diane L.  Back

doi:10.4236/ss.2014.55039

Aodhnait S. Fahy^*, Fabian Wong, Kumarapathan Kunasingam, Daniel Neen, Frances Dockery, Adil Ajuied, Diane L. Back

Abstract: As the number of aged patients presenting with hip fractures continues to rise [1], the substantial mortality associated with this pathology must continue to be an area of scrutiny and improvement. While some dismiss the high mortality as an inevitable consequence of the comorbidities inherent in the original injury and the patient population, data suggest that at 2 years post-hip fracture, survivors’ risks have regressed significantly and in fact, return to the same mortality risk as the non-fracture population [2]. This indicates that the risk of death is largely created specifically by the hip fracture and its treatment per se rather than the comorbidities of the hip fracture population, and offers scope for the potential reduction of these causes of death if we can identify and manage them appropriately. At a time when the incidence of hip fracture worldwide is on a steady rise, this review considers why and how these older patients die, and whether our developing guidelines and continuing research is adequately addressing these causes of death.

Keywords: Hip Fracture, Mortality, Older People, Proximal Femoral Fracture, Postoperative

Cite this paper: Fahy, A. , Wong, F. , Kunasingam, K. , Neen, D. , Dockery, F. , Ajuied, A. and Back, D. (2014) A Review of Hip Fracture Mortality—Why and How Does Such a Large Proportion of These Elderly Patients Die?. Surgical Science, 5, 227-232. doi: 10.4236/ss.2014.55039.

References

[1] National Hip Fracture Database (2012) www.nhfd.co.uk

[2] Richmond, J., Aharonoff, G.B., Zuckerman, J.D. and Koval, K.J.J (2003) Mortality Risk after Hip Fracture. Orthopaedics and Trauma, 17, 53-56.

[3] White, S.M. and Griffiths, R. (2011) Projected Incidence of Proximal Femoral Fracture in England: A Report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury, 42, 1230-1233. http://dx.doi.org/10.1016/j.injury.2010.11.010

[4] Perez, J.V., Warwick, D.J., Case, C.P. and Bannister, G.C. (1992) Death after Proximal Femoral Fracture—An Autopsy Study. Injury, 26, 237-240.

[5] Roche, J.J., Wenn, R.T., Sahota, O. and Moran, C.G. (2005) Effect of Comorbidities and Post-Operative Complications on Mortality after Hip Fracture in Elderly People: Prospective Observational Cohort Study. BMJ, 331, 1374. http://dx.doi.org/10.1136/bmj.38643.663843.55

[6] Garbharran, U., Chinthapalli, S., Hopper, I., George, M., Back, D.L. and Dockery, F. (2013) Red Cell Distribution Width Is an Independent Predictor of Mortality in Hip Fracture. Age Ageing, 42, 258-261. http://dx.doi.org/10.1093/ageing/afs176

[7] Myers, A.H., Robinson, E.G., Van Natta, M.L., Michelson, J.D., Collins, K. and Baker, S.P. (1991) Hip Fractures among the Elderly: Factors Associated with In-Hospital Mortality. American Journal of Epidemiology, 134, 1128-1137.

[8] Silber, J.H., Williams, S.V., Krakauer, H. and Schwartz, J.S. (1992) Hospital and Patient Characteristics Associated with Death after Surgery—A Study of Adverse Occurrence and Failure to Rescue. Medical Care, 30, 615-629. http://dx.doi.org/10.1097/00005650-199207000-00004

[9] Urban, M.K., Markoqitz, S.M., Gordon, M.A., Urquhart, B.L. and Kligfield, P. (2000) Post-Operative Prophylactic Administration of Beta-Adrenergic Blockers in Patients at Risk for Myocardial Ischemia. Anesthesia & Analgesia, 90, 1257-1261. http://dx.doi.org/10.1097/00000539-200006000-00001

[10] Matot, I., Oppenheim-Eden, A., Ratrot, R., et al. (2003) Pre-Operative Cardiac Events in Elderly Patients with Hip Fracture Randomised to Epidural or Conventional Analgesia. Anaesthesiology, 98, 156-163. http://dx.doi.org/10.1097/00000542-200301000-00025

[11] Carbone, L., Buzkova, P., Fink, H.A., et al. (2010) Hip Fractures and Heart Failure: Findings from the Cardiovascular Health Study. European Heart Journal, 31, 77-84.
http://dx.doi.org/10.1093/eurheartj/ehp483

[12] Oscarsson, A., Fredrikson, M., Sorliden, M., Anskar, S. and Eintrei, C. (2009) N-Terminal Fragment of Pro-B-Type Natriueretic Peptide Is A Predictor of Cardiac Events in High-Risk Patients Undergoing Acute Hip Fracture Surgery. British Journal of Anaesthesia, 103, 206-212.
http://dx.doi.org/10.1093/bja/aep139

[13] Heyburn, G. and McBrien, M.E. (2012) Preoperative Echocardiography for Hip Fractures: Time to Make It A Standard of Care. Anaesthesia, 67, 1189-1193.
http://dx.doi.org/10.1111/j.1365-2044.2012.07330.x

[14] Mak, J.C., Cameron, I.D. and March, L.M. (2010) National Health and Medical Research Council. Evidence-Based Guidelines for the Management of Hip Fractures in Older Persons: An Update. Medical Journal of Australia, 192, 37-41.

[15] Moja, L., Piatti, A., Pecoraro, V., et al. (2012) Timing Matters in Hip Fracture Surgery: Patients Operated within 48 Hours Have Better Outcomes. A Meta-Analysis and Meta-Regression of over 190,000 Patients. PLoS One, 7, Article ID: e46175. http://dx.doi.org/10.1371/journal.pone.0046175

[16] Parker, M.J., Handoll, H.H. and Griffiths, R. (2004) Anaesthesia for Hip Fracture Surgery in Adults. Cochrane Database of Systematic Reviews, 19, Article ID: CD000521.

[17] Gillespie, W.J. and Walenkamp, G.H. (2010) Antibiotic Prophylaxis for Surgery for Proximal Femoral and Other Closed Long Bone Fractures. Cochrane Database of Systematic Reviews, 17, Article ID: CD000244.

[18] Marsland, D., Mears, S.C. and Kates, S.L. (2010) Venous Thromboembolism Prophylaxis for Hip Fractures. Osteoporosis International, 21, S593-S604. http://dx.doi.org/10.1007/s00198-010-1403-2

[19] Rosencher, N., Vielpeau, C., Emmerich, J., Fagnani, F., Samama, C.M., ESCORTE Group (2005) Venous Thromboembolism and Mortality after Hip Fracture Surgery: The ESCORTE Study. Journal of Thrombosis and Haemostasis, 3, 2006-2014. http://dx.doi.org/10.1111/j.1538-7836.2005.01545.x

[20] Kannegaard, P.N., van der Mark, S., Eiken, P. and Abrahamsen, B. (2010) Excess Mortality in Men Compared with Women Following a Hip Fracture. National analysis of comedications, comorbidity and survival. Age and Ageing, 39, 203-29. http://dx.doi.org/10.1093/ageing/afp221

[21] Duncan, D.G., Beck, S.J., Hood, K. and Johansen, A. (2006) Using Dietetic Assistants to Improve the Outcome of Hip Fracture: A Randomised Controlled Trial of Nutritional Support in an Acute Trauma Ward. Age and Ageing, 35, 148-153. http://dx.doi.org/10.1093/ageing/afj011

[22] Aharonoff, G.B., Koval, K.J., Skovron, M.L. and Zuckerman, J.D. (1997) Hip Fractures in the Elderly: Predictors of One Year Mortality. Journal of Orthopaedic Trauma, 11, 162-165.
http://dx.doi.org/10.1097/00005131-199704000-00004

[23] Maxwell, M.J., Moran, C.G. and Moppett, I.K. (2008) Development and Validation of A Pre-Operative Scoring System to Predict 30 day Mortality in Patients Undergoing Hip Fracture Surgery. British Journal of Anaesthesia, 101, 511-517. http://dx.doi.org/10.1093/bja/aen236

[24] Seitz, D.P., Adunuri, N., Gill, S.S. and Rochon, P.A. (2011) Prevalence of Dementia and Cognitive Impairment among Older Adults with Hip Fractures. Journal of the American Medical Directors Association, 12, 556-564. http://dx.doi.org/10.1093/bja/aen236

[25] Vochteloo, A.J.H., Moerman, S., van der Burg, B., et al. (2011) Delirium Risk Screening and Haloperidol Prophylaxis Program in Hip Fracture Patients Is a Helpful Tool in Identifying High-Risk Patients, but Does Not Reduce the Incidence of Delirium. BMC Geriatrics, 11, 39.

[26] Mosfeldt, M., Pedersen, O.B., Riis, T., et al. (2012) Value of Routine Blood Tests for Prediction of Mortality Risk in Hip Fracture Patients. Acta Orthopaedica, 83, 31-35.
http://dx.doi.org/10.3109/17453674.2011.652883

[27] Sund, R. (2010) Modeling the Volume-Effectiveness Relationship in the Case of Hip Fracture Treatment in Finland. Clinical Orthopaedics and Related Research, 468, 2218-2223.

[28] Schilling, P., Goulet, J.A. and Dougherty, P.J. (2011) Do Higher Hospital-wide Nurse Staffing Levels Reduce In-hospital Mortality in Elderly Patients with Hip Fractures: A Pilot Study. Clinical Orthopaedics and Related Research, 469, 2932-2940. http://dx.doi.org/10.1007/s11999-011-1917-8

[29] Nielsen, K.A., Jensen, J.C., Jensen, C.M., et al. (2009) Quality of Care and 30 day Mortality among Patients with Hip Fractures: A Nationwide Cohort Study. BMC Health Services Research, 12, 186.

[30] Vidan, M., Serra, J.A., Moreno, C., Riquelme, G. and Ortiz, J. (2005) Efficacy of a Comprehensive Geriatric Intervention in Older Patients Hospitalized for Hip Fracture: A Randomized, Controlled Trial. Journal of the American Geriatrics Society, 53, 1476-1482. http://dx.doi.org/10.1111/j.1532-5415.2005.53466.x

[31] NICE Hip Fracture Guidelines (2011) http://guidance.nice.org.uk/CG124