title: Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study.
abstract: OBJECTIVE
  To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  2448 consecutive patients admitted with an acute hip 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.
  
  
  METHODS
  Routine care for hip fractures.
  
  
  METHODS
  Postoperative complications and mortality at 30 days and one year.
  
  
  RESULTS
  Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart 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 developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3).
  
  
  CONCLUSIONS
  In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.
authors.affiliation: Department of Trauma and Orthopaedics, University Hospital Nottingham, Nottingham, NG7 2UH.
authors.forename: J J W
authors.initials: JJ
authors.lastname: Roche
authors.forename: R T
authors.initials: RT
authors.lastname: Wenn
authors.forename: O
authors.initials: O
authors.lastname: Sahota
authors.forename: C G
authors.initials: CG
authors.lastname: Moran
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*