title: Patients With Multiple Myeloma Have More Complications After Surgical Treatment of Hip Fracture.
abstract: OBJECTIVE
  Bone lesions from multiple myeloma may lead to pathological fracture of the proximal femur, requiring either fixation or arthroplasty. Little is known about the impact of multiple myeloma on hip fracture care. We investigated whether the patients with multiple myeloma undergoing surgical treatment of hip fractures would be at increased risk for adverse outcomes versus patients who sustain a hip fracture without multiple myeloma.
  
  
  METHODS
  Using discharge records from the Nationwide Inpatient Sample (2002-2011), we identified 2 440 513 patients older than 50 years of age with surgically treated hip fractures. Of which, 4011 (0.2%) were found to have multiple myeloma. We compared perioperative outcomes between the patients with multiple myeloma and the nonmultiple myeloma patients using multivariable logistic regression modeling.
  
  
  RESULTS
  Patients with multiple myeloma were more likely to have several postoperative complications, such as in-hospital pneumonia (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.14-1.51), sepsis (OR: 1.72, 95% CI: 1.32-2.25), surgical site infection (OR: 1.66, 95% CI: 1.38-2.00), and acute renal failure (OR: 1.28, 95% CI: 1.14-1.43). We found that myeloma was not associated with increased inpatient mortality, myocardial infarction, respiratory failure, thromboembolic events, or pulmonary embolism.
  
  
  CONCLUSIONS
  Patients with multiple myeloma are at increased risk for immediate postoperative complications following surgical treatment of hip fractures including in-hospital pneumonia, surgical site infection, and acute renal failure but not hospital mortality, when compared to hip fracture patients without multiple myeloma. Perioperative management of hip fractures in patients with myeloma may be optimized by increased awareness of these risks in this subset of patients.
authors.affiliation: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Kwan Jun
authors.initials: KJ
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.affiliation: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mears
authors.affiliation: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: C Lowry
authors.initials: CL
authors.lastname: Barnes
keywords: complications; hip fractures; mortality; multiple myeloma; outcome; perioperative