Predictors of in-hospital mortality following operative management of hip fractures.
OBJECTIVE
To identify predictors of in-hospital mortality and hospital stay following hip fractures.


METHODS
Retrospective cohort study of 185 consecutive patients.


METHODS
Tertiary Care University Hospital.


METHODS
Individuals requiring operative treatment of a proximal femoral fracture excluding those individuals < 50 years old, with femoral head or subtrochanteric fractures, and significant co-morbidity.


RESULTS
In-hospital mortality and length of hospital stay (days).


RESULTS
116 patients met the inclusion criteria. Predictors of in-hospital mortality from logistic regression analysis included male gender (odds ratio with 95% CI: 5.5, 1.5-20.5), admission from a long term care facility (5.5, 1.4-22.6), age greater than 90 years (4.5, 0.9-22.1), and living at home with support (0.2, 0.03-0.9). Predictors of hospital stay from multivariate regression analysis in order of magnitude included presence of a post-operative complication (odds ratio with 95% CI: 14.1, 4.7-44), living at home with support (3.4, 1.3-8.9) and older age (> 85 years) (2.7, 1.0-7.3). Moreover, confusion, urinary tract infections and decubitus ulcers accounted for greater than 50% of all complications encountered. A trend between the number of positive predictors and length of hospital stay was observed.


CONCLUSIONS
Elderly individuals admitted from a long term care facility are at high risk of mortality following operative fixation of hip fractures. Early recognition and aggressive management of post-operative complications such as confusion, urinary tract infections and decubitus ulcers through careful patient monitoring may decrease hospital stays in those that survive.
Bhandari
M
M
Hamilton Civic Hospitals Research Center, Division of Orthopaedic Surgery, 711 Concession Street, Hamilton, Ontario, Canada L8V 1C3. bhandari@netinc.ca
Koo
H
H
Saunders
L
L
Shaughnessy
S G
SG
Dunlop
R B
RB
Schemitsch
E H
EH
D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery; D006620:Hip Fractures / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies