Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study

doi:10.1136/bmj.38643.663843.55

BMJ 2005;331:1374 (10 December), doi:10.1136/bmj.38643.663843.55 (published 18 November 2005)

Paper

Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study

J J W Roche, clinical fellow¹, R T Wenn, audit coordinator¹, O Sahota, consultant physician², C G Moran, professor¹

¹ Department of Trauma and Orthopaedics, University Hospital Nottingham, Nottingham, NG7 2UH, ² Department of Care of the Elderly, University Hospital Nottingham, Nottingham

Correspondence to: C G Moran anne.hay{at}qmc.nhs.uk

Objectives To evaluate postoperative medical complications andthe association between these complications and mortality at30 days and one year after surgery for hip fracture and to examinethe association between preoperative comorbidity and the riskof postoperative complications and mortality.

Design Prospective observational cohort study.

Setting University teaching hospital.

Participants 2448 consecutive patients admitted with an acutehip fracture over a four year period. We excluded 358 patients:all those aged < 60; those with periprosthetic fractures,pathological fractures, and fractures treated without surgery;and patients who died before surgery.

Interventions Routine care for hip fractures.

Main outcome measures Postoperative complications and mortalityat 30 days and one year.

Results Mortality was 9.6% at 30 days and 33% at one year. Themost common postoperative complications were chest infection(9%) and heart failure (5%). In patients who developed postoperativeheart failure mortality was 65% at 30 days (hazard ratio 16.1,95% confidence interval 12.2 to 21.3). Of these patients, 92%were dead by one year (11.3, 9.1 to 14.0). In patients who developeda postoperative chest infection mortality at 30 days was 43%(8.5, 6.6 to 11.1). Significant preoperative variables for increasedmortality at 30 days included the presence of three or morecomorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3to 2.5), and malignancy (1.5, 1.01 to 2.3).

Conclusions In elderly people with hip fracture, the presenceof three or more comorbidities is the strongest preoperativerisk factor. Chest infection and heart failure are the mostcommon postoperative complications and lead to increased mortality.These groups offer a clear target for specialist medical assessment.

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