title: Perioperative risk factors in patients with a femoral neck fracture - influence of 25-hydroxyvitamin D and C-reactive protein on postoperative medical complications and 1-year mortality.
abstract: BACKGROUND
  This study examined the association of 25-hydroxyvitamin D (25(OH)D) and C-reactive protein (CRP) with postoperative medical complications and one year mortality of elderly patients sustaining a low-energy cervical hip fracture scheduled for surgery. We hypothesized that vitamin D deficiency and CRP in these patients might be associated with an increased 1-year mortality.
  
  
  METHODS
  The prospective single-center cohort study included 209 patients with a low-energy medial femoral neck fracture; 164 women aged over 50 years and 45 men aged over 60 years. Referring to 1-year mortality and postoperative medical complications multiple logistic regression analysis including 10 co-variables (age, sex, BMI, ASA, creatinine, CRP, leukocytes hemoglobin, 25(OH)D, vitamin D supplementation at follow-up) was performed.
  
  
  RESULTS
  Vitamin D deficiency was prevalent in 87 % of all patients. In patients with severe (<10 ng/ml) and moderate (10-20 ng/ml) vitamin D deficiency one year mortality was 29 % and 13 %, respectively, compared to 9 % in patients with > 20 ng/ml 25(OH)D levels (p =0.027). Patients with a mild (CRP 10-39.9 mg/l) or active inflammatory response (CRP ≥ 40 mg/l) showed a higher one year mortality of 33 % and 40 % compared to 16 % in patients with no (CRP < 10 mg/l) inflammatory response (p = 0.002). Multiple logistic regression analysis identified CRP (OR 1.01, 95 % CI 1.00-1.02; p = 0.007), but not 25(OH)D (OR 0.97, 95 % CI 0.89-1.05; p = 0.425) as an independent predictor for one year mortality. 20 % of patients suffered in-hospital postoperative medical complications (i.e. pneumonia, thromboembolic events, etc.). 25(OH)D (OR 0.89, 95 % CI 0.81-0.97; p = 0.010), but not CRP (OR 1.01, 95 % CI 1.00-1.02; p = 0.139), was identified as an independent risk factor.
  
  
  CONCLUSIONS
  In elderly patients with low-energy cervical hip fracture, 25(OH)D is independently associated with postoperative medical complications and CRP is an independent predictor of one year mortality.
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Germany. johannes.fakler@medizin.uni-leipzig.de.
authors.forename: Johannes K M
authors.initials: JK
authors.lastname: Fakler
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Germany. antonia.grafe@web.de.
authors.forename: Antonia
authors.initials: A
authors.lastname: Grafe
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Germany. jamila.dinger@gmail.com.
authors.forename: Jamila
authors.initials: J
authors.lastname: Dinger
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Germany. christoph.josten@medizin.uni-leipzig.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Josten
authors.affiliation: Research Laboratories of the Department of Orthopedics, Trauma and Plastic Surgery, University Hospital of Leipzig AöR, Liebigstr. 20, Leipzig, 04103, Germany. gabriela.aust@medizin.uni-leipzig.de.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Aust
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D005265:Femoral Neck Fractures / Q000097:blood / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects* / Q000401:mortality; D005858:Germany; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000150:complications / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood* / Q000150:complications / Q000401:mortality
chemical_list: D015415:Biomarkers; D014807:Vitamin D; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D
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