Skip to main content

Advertisement

Log in

Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Study design

Retrospective review of prospectively collected data.

Objective

To describe the impact of patient demographics, injury-specific factors, and medical co-morbidities on outcomes after hip fracture using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB).

Methods

The 2008 NSP-NTDB was queried to identify patients sustaining hip fractures. Patient demographics, co-morbidities, injury-specific factors, and outcomes (including mortality and complications) were recorded and a national estimate model was developed. Unadjusted differences for risk factors were evaluated using t test/Wald Chi square analyses. Weighted logistic regression and sensitivity analyses were performed to control for all factors in the model.

Results

The weighted sample contained 44,419 incidents of hip fracture. The average age was 72.7. Sixty-two percent of the population was female and 80 % was white. The mortality rate was 4.5 % and 12.5 % sustained at least one complication. Seventeen percent of patients who sustained at least one complication died. Dialysis, presenting in shock, cardiac disease, male sex, and ISS were significant predictors of mortality, while dialysis, obesity, cardiac disease, diabetes, and a procedure delay of ≥2 days influenced complications. The major potential modifiable risk factor appears to be time to procedure, which had a significant impact on complications.

Conclusions

This is the first study to postulate predictors of morbidity and mortality following hip fracture in a US national model. While many co-morbidities appear to be influential in predicting outcome, some of the more significant factors include the presence of shock, dialysis, obesity, and time to surgery.

Level of evidence

Prognostic study, Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  PubMed  Google Scholar 

  2. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  3. Haleem S, Lutchman l, Mayahi R, Grice JE, Parker MJ (2008) Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 39:1157–1163

    Article  CAS  PubMed  Google Scholar 

  4. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302:1573–1579

    Article  CAS  PubMed  Google Scholar 

  5. Hip fractures among older adults. Atlanta: Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. http://www.cdc.gov/ncipc/factsheets/adulthip-fx.htm. Accessed 17 June 2012

  6. Hochberg MC, Williamson J, Skinner EA et al (1998) The prevalence and impact of self-reported hip fracture in elderly community-dwelling women: the Women’s Health and Aging Study. Osteoporos Int 8:385–389

    Article  CAS  PubMed  Google Scholar 

  7. Leslie WD, O’Donnell S, Jean S et al (2009) Trends in hip fractures in Canada. JAMA 302:883–889

    Article  CAS  PubMed  Google Scholar 

  8. Parker MJ, Handoll HH, Griffiths R (2004) Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 4:CD000521

    PubMed  Google Scholar 

  9. Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152(6):380–390

    Article  PubMed Central  PubMed  Google Scholar 

  10. Moran CG, Wenn RT, Sikand M et al (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489

    Article  PubMed  Google Scholar 

  11. Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ (2003) Mortality risk after hip fracture. 2003. J Orthop Trauma 17(8 Suppl):S2–S5

    Article  PubMed  Google Scholar 

  12. Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Rosell PA, Parker MJ (2003) Functional outcome after hip fracture. A 1-year prospective outcome study of 275 patients. Injury 34:529–532

    Article  CAS  PubMed  Google Scholar 

  14. Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD (1998) Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res 348:22–28

    PubMed  Google Scholar 

  15. Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD (1995) Ambulatory ability after hip fracture in the elderly. A prospective study in geriatric patients. Clin Orthop Relat Res 310:150–159

    PubMed  Google Scholar 

  16. Pretto M, Spirig R, Kaelin R, Muri-John V, Kressig RW, Suhm N (2010) Outcomes of elderly hip fracture patients in the Swiss healthcare system. Swiss Med Wkly 140:w13086

    PubMed  Google Scholar 

  17. Bosch U, Schreiber T, Krettek C (2002) Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res 399:59–71

    Article  PubMed  Google Scholar 

  18. Zuckerman JD (1996) Hip fracture. N Engl J Med 334:1519–1525

    Article  CAS  PubMed  Google Scholar 

  19. Elder GM, Harvey EJ, Vaidya R, Guy P, Meek RN, Aebi M (2005) The effectiveness of orthopaedic trauma theatres in decreasing morbidity and mortality: a study of 701 displaced subcapital hip fractures in two trauma centres. Injury 36:1060–1066

    Article  CAS  PubMed  Google Scholar 

  20. Butler P, Forte ML, Joglekar SB, Swiontkowski MF, Kane RL (2011) Evidence summary: systematic review of surgical treatments for geriatric hip fractures. J Bone Joint Surg Am 93:1104–1115

    Article  PubMed  Google Scholar 

  21. Sullivent EE, Faul M, Wald MM (2011) Reduced mortality in injured adults transported by helicopter emergency medical services. Prehosp Emerg Care 15:295–302

    Article  PubMed  Google Scholar 

  22. Bukur M, Castelo Branco B, Inaba K, Cestero R, Kobayashi L, Tang A, Demetriades D (2012) The impact of American College of Surgeons trauma center designation and outcomes after early thoracotomy: a National Trauma Databank analysis. Am Surg 78:36–41

    PubMed  Google Scholar 

  23. Branco BC, Inaba K, Bukur M, Talving P, Oliver M, David JS, Lam L, Demetriades D (2011) Risk factors for delirium in trauma patients: the impact of ethanol use and lack of insurance. Am Surg 77:621–626

    PubMed  Google Scholar 

  24. Sperry JL, Vodovotz Y, Ferrell RE, Namas R, Chai YM, Feng QM, Jia WP, Forsythe RM, Peitzman AB, Billiar TR (2012) Racial disparities and sex-based outcomes differences after severe injury. J Am Coll Surg 214:973–980

    Article  PubMed Central  PubMed  Google Scholar 

  25. Haider AH, Saleem T, Leow JJ, Villegas CV, Kisat M, Schneider EB, Haut ER, Stevens KA, Cornwell EE 3rd, MacKenzie EJ, Efron DT (2012) Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact? J Am Coll Surg 214:756–768

    Article  PubMed Central  PubMed  Google Scholar 

  26. American College of Surgeons. National Trauma Data Bank (NTDB) National sample Program, Arrival Year 2008 (February, 2010). Instructional Manual. Available at: http://www.facs.org/trauma/ntdb/nsp.html. Accessed 3 June 2012

  27. Endo Y, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ (2005) Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma 19:29–35

    Article  PubMed  Google Scholar 

  28. Smektala R, Endres H, Dasch B et al (2008) The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord 9:171

    Article  PubMed Central  PubMed  Google Scholar 

  29. Hu F, Jiang C, Shen J, Tang P, Wang Y (2011) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43(6):676–685

    PubMed  Google Scholar 

  30. Alzahrani K, Gandhi R, Davis A, Mahomed N (2010) In-hospital mortality following hip fracture care in southern Ontario. Can J Surg 53:294–298

    PubMed Central  PubMed  Google Scholar 

  31. Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV (2011) Risk factors for in-hospital post-hip fracture mortality. Bone 49:553–558

    Article  PubMed  Google Scholar 

  32. Johansen A, Mansor M, Mahoney H, Thomas S (2010) Outcome following hip fracture: post-discharge residence and long term mortality. Age Ageing 39:653–656

    Article  PubMed  Google Scholar 

  33. Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: an observational study. BMJ 332:947–951

    Article  PubMed Central  PubMed  Google Scholar 

  34. Kang H, Yang K, Kim YN, Moon S, Choi W, Kang DR, Park SE (2010) Incidence and mortality of hip fracture among elderly population in South Korea: a population-based study using the National Health Insurance claims data. BMC Public Health 10:230–239

    Article  PubMed Central  PubMed  Google Scholar 

  35. Kannegaard PN, Van Der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209

    Article  PubMed  Google Scholar 

  36. Holt G, Smith R, Duncan K, McKeown DW (2010) Does delay to theatre for medical reasons affect the peri-operative mortality in patients with a fracture of the hip? J Bone Joint Surg Br 92-B:835–841

    Article  Google Scholar 

  37. Simunovic N, Devereaux MD, Sprague S, Guyatt GH, Schemitsch E, DeBeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182(15):1609–1616

    Article  PubMed Central  PubMed  Google Scholar 

  38. Carretta E, Bochicchio V, Rucci P, Fabbri G, Laus M, Fantini MP (2011) Hip fracture: effectiveness of early surgery to prevent 30-day mortality. Int Orthop 35:419–424

    Article  PubMed Central  PubMed  Google Scholar 

  39. McGuire KJ, Bernstein J, Polsky D, Silber JH (2004) The 2004 Marshal Urist award: delays until surgery after hip fracture increase mortality. Clin Orthop Relat Res 428:294–301

    Article  PubMed  Google Scholar 

  40. Holt G, Smith R, Duncan K, Finlayson DF, Gregori A (2008) Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from Scotish hip fracture audit. J Bone Joint Surg Br 90(10):1357–1363

    Article  CAS  PubMed  Google Scholar 

  41. Sund R, Liski A (2005) Quality effects of operative delay on mortality in hip fracture treatment. Qual Saf Health Care 14(5):371–377

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Rodriguez-Fernandez P, Adarraga-Cansino, Carpintero P (2011) Effects of delayed hip fracture surgery on mortality and morbidity in elderly patients. Clin Orthop Relat Res 469:3218–3221

    Article  PubMed Central  PubMed  Google Scholar 

  43. Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ (2009) Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury 40(7):692–697

    Article  PubMed  Google Scholar 

  44. Shiga T, Wajima A, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 55(3):146–154

    Article  PubMed  Google Scholar 

  45. Cameron ID, Chen JS, March LM, Simpson JM, Cumming RG, Seibel MJ, Sambrook PN (2010) Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: a prospective 5-year study. J Bone Miner Res 25(4):866–872

    PubMed  Google Scholar 

  46. Edwards C, Counsell A, Boulton C, Moran CG (2012) Early infection after hip fracture surgery: risk factors, costs and outcome. J Bone Joint Surg Br 90-B:770–777

    Article  Google Scholar 

  47. Garcia-Alvarez F, Al-Ghanem R, Garcia-Alvarez I, Lopez-Baisson A, Bernal M (2010) Risk factors for postoperative infections in patients with hip fracture treated by means of Thompson arthroplasty. Arch Gerontol Geriatr 50:51–55

    Article  CAS  PubMed  Google Scholar 

  48. Harrison T, Robinson P, Cook A, Parker MJ (2012) Factors affecting the incidence of deep wound infection after hip fracture surgery. J Bone Joint Surg Br 94:237–240

    Article  CAS  PubMed  Google Scholar 

  49. Merrer J, Girou E, Lortat-Jacob A, Montravers P, Lucet J (2007) Surgical site infection after surgery to repair femoral neck fracture: a French multicenter retrospective study. Infect Control Hosp Epidemiol 28(10):1169–1174

    Article  PubMed  Google Scholar 

  50. Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91(7):922–927

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew J. Schoenfeld.

Additional information

Investigation Performed at William Beaumont Army Medical Center, El Paso, TX

Rights and permissions

Reprints and permissions

About this article

Cite this article

Belmont, P.J., Garcia, E.J., Romano, D. et al. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg 134, 597–604 (2014). https://doi.org/10.1007/s00402-014-1959-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-1959-y

Keywords

Navigation