title: Postoperative Mortality after Hip Fracture Surgery: A 3 Years Follow Up.
abstract: OBJECTIVE
  To determine mortality rates and predisposing factors in patients operated for a hip fracture in a 3-year follow-up period.
  
  
  METHODS
  The study included patients who underwent primary surgery for a hip fracture.The inclusion criteria were traumatic, non-traumatic, osteoporotic and pathological hip fractures requiring surgery in all age groups and both genders. Patients with periprosthetic fractures or previous contralateral hip fracture surgery and patients who could not be contacted by telephone were excluded. At 36 months after surgery, evaluation was made using a structured telephone interview and a detailed examination of the hospital medical records, especially the documents written during anesthesia by the anesthesiologists and the documents written at the time of follow-up visits by the orthopaedic surgeons. A total of 124 cases were analyzed and 4 patients were excluded due to exclusion criteria. The collected data included demographics, type of fracture, co-morbidities, American Society of Anesthesiologists (ASA) scores, anesthesia techniques, operation type (intramedullary nailing or arthroplasty; cemented-noncemented), peroperative complications, refracture during the follow-up period, survival period and mortality causes.
  
  
  RESULTS
  The total 120 patients evaluated comprised 74 females(61.7%) and 46 males(38.3%) with a mean age of 76.9±12.8 years (range 23-95 years). The ASA scores were ASA I (0.8%), ASA II (21.7%), ASA III (53.3%) and ASA IV (24.2%). Mortality was seen in 44 patients (36.7%) and 76 patients (63.3%) survived during the 36-month follow-up period. Of the surviving patients, 59.1% were female and 40.9% were male.The survival period ranged between 1-1190 days. The cumulative mortality rate in the first, second and third years were 29.17%, 33.33% and 36.67% respectively. The factors associated with mortality were determined as increasing age, high ASA score, coronary artery disease, congestive heart failure, Alzheimer's disease, Parkinson's disease, malignancycementation and peroperative complications such as hypotension (p<0.05). Mortality was highest in the first month after fracture.
  
  
  CONCLUSIONS
  The results of this study showed higher mortality rates in patients with high ASA scores due to associated co-morbidities such as congestive heart failure, malignancy and Alzheimer's disease or Parkinson's disease. The use of cemented prosthesis was also seen to significantly increase mortality whereas no effect was seen from the anesthesia technique used. Treatment of these patients with a multidiciplinary approach in an orthogeriatric ward is essential. There is a need for further studies concerning cemented vs. uncemented implant use and identification of the best anesthesia technique to decrease mortality rates in these patients.
authors: Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Oya
authors: http://orcid.org/0000-0003-2082-2127
authors: O
authors: Kilci
authors: Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Canan
authors: C
authors: Un
authors: Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Ozlem
authors: O
authors: Sacan
authors: Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Mehmet
authors: M
authors: Gamli
authors: Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Semih
authors: S
authors: Baskan
authors: Department of Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Mustafa
authors: M
authors: Baydar
authors: Department of Orthopedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
authors: Bulent
authors: B
authors: Ozkurt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011184:Postoperative Period; D012189:Retrospective Studies; D055815:Young Adult