title: The proportion of perioperative mortalities attributed to cemented implantation in hip fracture patients treated by hemiarthroplasty.
abstract: BACKGROUND
  Bone cement for fixation of prostheses, comorbidity and age have been previously shown to be associated with increased relative risk of mortality within the first day of surgery. However, the proportion of mortalities associated to each of these exposures is not adequately expressed by relative risk estimates.
  
  
  METHODS
  The attributable fraction (AF), i.e., the fraction of diseased individuals attributed to a given risk factor, was estimated for cemented fixation of hip prostheses in the elderly (>65 years) with a hip fracture. Dementia, symptomatic comorbidity (American Society of Anesthesiologists (ASA)≥ 3), old age (≥85 years), male gender, and a delay of 24 hours or more from fracture to operation were considered as additional risk factors for a fatal outcome in close proximity to surgery.
  
  
  RESULTS
  In the entire study population (n = 11210), the unadjusted and adjusted population AFs of cemented fixation on mortalities within the first day after surgery were 0.58 (95% CI 0.28-0.76) and 0.59 (95% CI 0.29-0.76), respectively. Symptomatic comorbidity and old age as risk factors had population AFs of 0.71 (95% CI 0.51-0.83) and 0.55 (95% CI 0.39-0.67), respectively. Male gender, dementia and time from fracture to operation all had considerably lower population AFs.
  
  
  CONCLUSIONS
  The estimated AFs on perioperative mortality in hip fracture patients treated by hemiarthroplasty showed that about half of the mortalities within the first day of surgery could be associated with the use of bone cement.
authors: 1 Department of Biostatistics, Epidemiology and Health Economics, Oslo University Hospital, Oslo - Norway.
authors: Are Hugo
authors: AH
authors: Pripp
authors: Ove
authors: O
authors: Talsnes
authors: Olav
authors: O
authors: Reikerås
authors: Lars B
authors: LB
authors: Engesæter
authors: Ola E
authors: OE
authors: Dahl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000379:methods* / Q000401:mortality; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements