Authors: Le Manach Y et al. JAMA 2015 Sep 15.
More than just age and medical comorbidity seem to be at work.
Excess mortality among hip fracture–surgery patients above that seen in total hip–replacement patients has been ascribed largely to age and medical comorbidities. This French study was designed to explore potentially modifiable risk factors that contribute to such excess mortality. Researchers identified 117,157 patients (mean age, 75) who underwent either hip fracture surgery or hip replacement surgery; patients in each group were matched for age and a wide range of medical comorbidities. About one third of patients had chronic metabolic, cardiac, or pulmonary comorbidities.
During 4 years of follow-up, 2180 in-hospital deaths occurred in hip fracture patients and 362 such deaths occurred in hip replacement patients. Major complications (including cardiac complications and admission to intensive care units) were about two to three times more common among hip fracture patients.
Although the hip fracture and hip replacement groups were matched by age and comorbid diagnoses, some obvious distinctions might explain differences in mortality and complications. Hip fracture admissions are unplanned, less opportunity exists to “fine-tune” comorbid medical conditions, and patients are more likely to be bedridden and to receive sedating opioids preoperatively. Nevertheless, the authors recommend that inflammatory, coagulation, and metabolic factors be explored as potential ways to improve outcomes with hip fracture surgery. They also suggest a focus on shortening delays between fracture and surgery.