Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study.
BACKGROUND
Recent changes in the management of hip fracture surgery patients may have modified the epidemiology of postoperative complications.


OBJECTIVE
We performed an observational study of a cohort of patients undergoing hip fracture surgery to update the epidemiological data on this population. The primary study outcome was the incidence of confirmed symptomatic venous thromboembolism (VTE) [defined as deep vein thrombosis, pulmonary embolism (PE), or both] at 3 months. Overall mortality at 1, 3 and 6 months was also evaluated.


METHODS
Consecutive patients aged at least 18 years hospitalized in French public or private hospitals (531 centers) undergoing hip fracture surgery were recruited prospectively during 2 months in 2002 and a follow-up at 6 months. Predictive factors for VTE at 3 months and for death at 6 months were also analyzed.


RESULTS
Data from 6860 (97.3%) of the 7019 recruited patients were included in the analysis. The median age was 82 years. Low molecular weight heparins were administered perioperatively in 97.6% of patients; 69.5% received this treatment for at least 4 weeks. The actuarial rate of confirmed symptomatic VTE at 3 months was 1.34% (85 events, 95% CI: 1.04-1.64). There were 16 PEs (actuarial rate: 0.25%), three of which were fatal. Overall, 1006 (14.7%) patients were dead at 6 months. Cardiovascular disease was the most frequent cause of death (270 patients; 26.8%).


CONCLUSIONS
The current rate of postoperative VTE is low, but overall mortality remains high. Indeed, hip fracture patients belong to a vulnerable group of old people with comorbid diseases and a high risk of postoperative morbidity and mortality. An interdisciplinary approach could be the challenge to improve short and long-term outcome.
Rosencher
N
N
Department of Anaesthesiology and Intensive Care, Paris Descartes University, AP-HP Hôpital Cochin, Paris, France. nadia.rosencher@cch.aphp.fr
Vielpeau
C
C
Emmerich
J
J
Fagnani
F
F
Samama
C M
CM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006620:Hip Fractures / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D016019:Survival Analysis; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*