title: Complications and Postoperative Mortality Rate After Surgery for Pathological Femur Fracture Related to Bone Metastasis: Analysis of a Nationwide Database.
abstract: BACKGROUND
  Currently, there are few reports regarding predictors of postoperative complications and short-term mortality after surgery for pathological femur fracture related to bone metastasis.
  
  
  METHODS
  Using data from the Japanese Diagnosis Procedure Combination Database from 2007 to 2012, we retrospectively identified 1497 patients who underwent internal fixation (n = 1073) or proximal femur resection and endoprosthetic reconstruction of the proximal femur (n = 424) for pathological femur fracture related to bone metastasis. Multivariable logistic regression analysis was performed to examine the relationship of various factors with postoperative complications and 30-day mortality.
  
  
  RESULTS
  The overall 30-day mortality after surgery was 2.6%, and the proportion of postoperative complications was 12.1%. Multivariable logistic regression analysis showed that postoperative complications overall were significantly associated with older age [odds ratio (OR), 2.15; 95% confidence interval (CI) 1.23-3.74 for age ≥80 vs. ≤59 years]; lung carcinoma (OR 2.05; 95% CI 1.47-2.86); esophageal carcinoma (OR 4.41; 95% CI 1.57-12.43); higher Charlson Comorbidity Index (OR 1.50; 95% CI 1.03-2.18 for ≥9 vs. 8); and blood transfusion (OR 1.57; 95% CI 1.14-2.15). Thirty-day mortality also was significantly higher in patients with rapid-growth tumors, visceral metastasis, internal fixation, and no postoperative chemotherapy in the univariate analysis.
  
  
  CONCLUSIONS
  Older age, type of primary tumor, higher Charlson Comorbidity Index, and blood transfusion were associated with higher morbidity. These findings can provide important information to assess perioperative risk in patients with pathological femur fracture related to bone metastasis.
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. ytsuda-tuk@umin.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsuda
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kawano
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D015897:Comorbidity; D005260:Female; D005264:Femoral Fractures / Q000401:mortality*; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate