title: Predictors of 30-day mortality following hip/pelvis fractures.
abstract: With the cost of healthcare in the United States reaching $2.9 trillion in 2013 and expected to increase with a growing geriatric population, the Center for Medicare and Medicaid Services (CMS) and Hospital Quality Alliance (HQA) began publicly reporting 30-day mortality rates so that hospitals and physicians may begin to confront clinical problems and promote high-quality and patient-centered care. Though the 30-day mortality is considered a highly effective tool in measuring hospital performance, little data actually exists that explores the rate and risk factors for trauma-related hip and pelvis fractures. Therefore, in this study, we sought to explore the risk factors associated with 30-day mortality in trauma-related hip and pelvic fractures.
  
  
  
  Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 341,062 patients undergoing orthopaedic procedures from 2005 to 2013 were identified through a Current Procedural Terminology (CPT) code search. A second CPT code search identified 24,805 patients who sustained a hip/pelvis fracture. Patient demographics, preoperative comorbidities, operative characteristics and postoperative complications were collected and compared using Chi-squared test, Wilcoxon-Mann-Whitney test and multivariate logistic regression analysis.
  
  
  
  Preoperative and postoperative risk factors for 30-day mortality following a hip/pelvis fracture were found: ASA classification, ascites, disseminated cancer, dyspnea, functional status, history of congestive heart failure (CHF), history of chronic obstructive pulmonary disease (COPD), a recent blood transfusion, and the postoperative complications: pneumonia, myocardial infarction, stroke, and septic shock.
  
  
  
  Several preoperative patient risk factors and postoperative complications greatly increased the odds for patient mortality following 30-days after initial surgery. Orthopaedic surgeons can utilize these predictive risk factors to better improve patient care.
  
  
  
  Retrospective study. Level IV.
authors: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.
authors: A C
authors: AC
authors: Dodd
authors: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.
authors: C
authors: C
authors: Bulka
authors: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.
authors: A
authors: A
authors: Jahangir
authors: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.
authors: H R
authors: HR
authors: Mir
authors: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.
authors: W T
authors: WT
authors: Obremskey
authors: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA. Electronic address: Manish.sethi@vanderbilt.edu.
authors: M K
authors: MK
authors: Sethi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000453:epidemiology*; D001803:Blood Transfusion; D015897:Comorbidity; D016208:Databases, Factual; D004417:Dyspnea / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000453:epidemiology*; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D009362:Neoplasm Metastasis; D019637:Orthopedic Procedures / Q000009:adverse effects; D010384:Pelvic Bones / Q000293:injuries*; D011183:Postoperative Complications / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: 30-day mortality; Complications; Hip fracture; Pelvis fracture; Risk factors