title: Predictors of early mortality after hip fracture surgery.
abstract: OBJECTIVE
  The aim of this study was to examine causes and potential risk factors for 30-day mortality after hip fracture surgery (HFS) at a high-volume tertiary-care hospital.
  
  
  METHODS
  We retrospectively reviewed 467 patients who underwent HFS at our institution. Multivariate analysis was undertaken to identify potential predictors of early mortality.
  
  
  RESULTS
  The 30-day mortality rate was 7.5% (35/467). The most common causes of death were pneumonia (37.1%, 13/35), acute coronary syndrome (31.4%, 11/35) and sepsis (14.3%, 5/35). Surgery after 48 hours of admission had a significantly higher 30-day mortality rate (11 % versus 4%, p = 0.006). There was a significant difference in age (p = 0.034), admission source (p < 0.001), preoperative haemoglobin (p < 0.001), walking ability (p = 0.004), number of comorbidities (p = 0.004) and pre-existing dementia (p = 0.01), cardiac disease (p < 0.001), chronic obstructive pulmonary disorder (COPD) (p = 0.036) and renal failure (p = 0.007) between the 30-day mortality group and the rest of the cohort. Surgical delay greater than 48 hours, admission source and pre-existing cardiac disease were identified as the strongest predictors of 30-day mortality.
  
  
  CONCLUSIONS
  Surgical delay is an important but avoidable determinant of early mortality after HFS. Respiratory and cardiac function needs to be optimised postoperatively with early intervention in patients with signs of cardiovascular compromise or infection.
authors: Department of Trauma & Orthopaedics, Hull Royal Infirmary, Anlaby Road, Hull, HU2 8JS, UK, asim2002@yahoo.com.
authors: Muhammad Asim
authors: MA
authors: Khan
authors: Fahad Siddique
authors: FS
authors: Hossain
authors: Iftikhar
authors: I
authors: Ahmed
authors: Nagarajan
authors: N
authors: Muthukumar
authors: Amr
authors: A
authors: Mohsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005592:Fracture Fixation; D006331:Heart Diseases / Q000453:epidemiology* / Q000401:mortality; D006620:Hip Fractures / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000401:mortality; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality; D015996:Survival Rate
references: Int Orthop. 2013 Jun;37(6):1135-40
references: 23508867
references: Injury. 2008 Jul;39(7):775-80
references: 18407276
references: J Am Geriatr Soc. 2007 Nov;55(11):1720-6
references: 17916118
references: JAMA. 2009 Oct 14;302(14):1573-9
references: 19826027
references: CMAJ. 2010 Oct 19;182(15):1609-16
references: 20837683
references: J Bone Joint Surg Br. 2012 May;94(5):690-7
references: 22529093
references: Int Orthop. 2012 Aug;36(8):1709-14
references: 22437265
references: Nihon Ronen Igakkai Zasshi. 2003 Nov;40(6):615-9
references: 14689854
references: JAMA. 2009 Oct 21;302(15):1666-73
references: 19843901
references: Injury. 1995 May;26(4):237-40
references: 7649622
references: Ulster Med J. 2006 Sep;75(3):200-6
references: 16964812
references: Int Orthop. 2011 Jun;35(6):903-7
references: 21079953
references: Osteoporos Int. 2013 Apr;24(4):1145-9
references: 22907738
references: Br J Anaesth. 2008 Oct;101(4):511-7
references: 18723517
references: Injury. 2012 Jun;43(6):676-85
references: 21683355
references: BMJ. 1993 Nov 13;307(6914):1248-50
references: 8166806
references: BMC Health Serv Res. 2009 Oct 12;9:186
references: 19822018
references: J Am Geriatr Soc. 2008 Apr;56(4):705-10
references: 18005354
references: Aging Clin Exp Res. 2006 Oct;18(5):381-7
references: 17167302
references: J Bone Miner Metab. 2006;24(2):100-4
references: 16502115
references: Public Health. 1991 Nov;105(6):443-6
references: 1803403
references: Ann Epidemiol. 2007 Jul;17(7):514-9
references: 17420142
references: Osteoporos Int. 2007 Oct;18(10):1355-62
references: 17492247
references: Int Orthop. 2011 Mar;35(3):419-24
references: 20373098
references: J Gen Intern Med. 1996 Dec;11(12):765-7
references: 9016427
references: J Hosp Med. 2012 Nov-Dec;7(9):713-6
references: 22956471