title: Complications and institutionalization are almost doubled after second hip fracture surgery in the elderly patient.
abstract: OBJECTIVE
  To determine patient and hip fracture characteristics, early postoperative complication rate, and need for institutionalization at the time of discharge from the hospital in patients treated for a second contralateral hip fracture.
  
  
  METHODS
  During a 6-year period (2003-2009), 71 patients (60 women and 11 men; age range, 54-94 years) underwent first hip fracture surgery and subsequent contralateral hip fracture surgery at our hospital. Variables, including age, gender, American Society of Anesthesiologists classification (ASA), AO fracture classification, time between both hip fractures, rate and severity of early postoperative complications, and destination of discharge were obtained from the electronic medical records. Data from both hospitalization periods were compared.
  
  
  RESULTS
  Forty-six percent of second hip fractures occurred within 2 years after the first hip fracture. After the first hip fracture surgery, 13 patients had 1 or multiple complications compared with 23 patients after a second hip fracture surgery (P = 0.02). The mean time (±SD) between the first and second hip fractures in patients without complications after the second injury was 4.3 (±4.2) years, compared with 2.6 (±2.1) years in patients with complications after the second injury (P = 0.03). The mean ASA classification of patients without complications after the second hip fracture surgery was 2.6 (±0.6) versus 3.0 (±0.6) in patients with complications (P = 0.04). After the first hip fracture surgery, 27 patients (38%) were discharged to an institutional care facility, whereas 72% of patients resided at an institutional care facility after a second hip fracture.
  
  
  CONCLUSIONS
  Early complication rate in patients sustaining a second contralateral hip fracture was almost twice that documented after the first hip fracture. After the second hip fracture surgery, most patients resided in an institutional care facility.
  
  
  METHODS
  Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Surgery, St. Elisabeth Hospital, Tilburg, the Netherlands; †Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; and ‡Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: van der Steenhoven
authors.forename: Bas
authors.initials: B
authors.lastname: Staffhorst
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Van de Velde
authors.forename: Rob G H H
authors.initials: RG
authors.lastname: Nelissen
authors.forename: Michiel H J
authors.initials: MH
authors.lastname: Verhofstad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence