Preoperative status and risk of complications in patients with hip fracture.
BACKGROUND
Limited information is available on preoperative status and risks for complications for older patients having surgery for hip fracture. Our objective was to identify potentially modifiable clinical findings that should be considered in decisions about the timing of surgery.


METHODS
We conducted a prospective cohort study with data obtained from medical records and through structured interviews with patients. A total of 571 adults with hip fracture who were admitted to 4 metropolitan hospitals were included.


RESULTS
Multiple logistic regression was used to identify risk factors (including 11 categories of physical and laboratory findings, classified as mild and severe abnormalities) for in-hospital complications. The presence of more than 1 (odds ratio [OR] 9.7, 95% confidence interval [CI] 2.8 to 33.0) major abnormality before surgery or the presence of major abnormalities on admission that were not corrected prior to surgery (OR 2.8, 95% CI 1.2 to 6.4) was independently associated with the development of postoperative complications. We also found that minor abnormalities, while warranting correction, did not increase risk (OR 0.70, 95% CI 0.28 to 1.73).


CONCLUSIONS
In this study of older adults undergoing urgent surgery, potentially reversible abnormalities in laboratory and physical examination occurred frequently and significantly increased the risk of postoperative complications. Major clinical abnormalities should be corrected prior to surgery, but patients with minor abnormalities may proceed to surgery with attention to these medical problems perioperatively.
McLaughlin
Mary Ann
MA
Mount Sinai School of Medicine, New York, NY, USA. maryann.mclaughlin@mssm.edu
Orosz
Gretchen M
GM
Magaziner
Jay
J
Hannan
Edward L
EL
McGinn
Thomas
T
Morrison
R Sean
RS
Hochman
Tsivia
T
Koval
Kenneth
K
Gilbert
Marvin
M
Siu
Albert L
AL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006620:Hip Fractures / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome