Correlation of preoperative co-morbidities with post-operative outcomes in patients operated for hip fractures

  • Dr. Rakesh R Goyal Post Graduate student, Department of Orthopedics, Vadilal Sarabhai General Hospital and Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Dr. Harsha Makwana Associate Professor, Emergency Medicine department, Vadilal Sarabhai General Hospital and Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Dr. Neel M Bhavsar Associate Professor, Department of Orthopedics, Vadilal Sarabhai General Hospital and Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Dr. Rameez A Musa Assistant professor, Department of Orthopedics, Vadilal Sarabhai General Hospital and Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Dr. Pankaj R Patel Dean, Professor, Department of Orthopedics, Vadilal Sarabhai General Hospital and Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
Keywords: Hip Fractures, Pre-operative co-morbidities, Post-operative mortality

Abstract

Introduction: As the population ages, disability and death is becoming more common in which hip fracture is one of the commonest cause. The purpose of this study is to analyse the effect of preoperative co-morbidities on postoperative outcomes in patients operated for hip surgery. This would also provide a reference for improved treatment and perioperative planning in order to have better survival chances in postoperative periods.

Methods: This is an observational study in elderly patients ranging from 50-110 years of age for isolated hip fractures operated at a tertiary care hospital in Ahmedabad from January 2015 to January 2016. Patients were analyzed for one month mortality after hip fracture fixation. The co-morbidities encountered were then co-related with mortalities and conclusion drawn.

Results: A total of 376 patients (54 percent males, 46 percent females) were taken for study. Analysis for one month mortality after hip fracture fixation showed that 7.7 percent deaths (45 percent males, 55 percent females) occurred within one month of operation. 51.7 percent of patients expired in first week. 17.2 percent in second week and 31.1 percent in later half of month.

Conclusion: Study showed that postoperative mortality was directly proportional to the number of pre-operative co-morbidities. Patients who had ≥ 3 comorbidities had higher mortality risk, with two co-morbidities moderate risk and those having one or no comorbidity had higher survival chances in postoperative period. The presence of 3 or more comorbidities is the strongest preoperative risk factor for postoperative outcome.

Downloads

Download data is not yet available.

References

Sinha AK, Boot DA, Gorman DF, Teanby DN.Severe motorcycle injury in Mersey region and North Wales. Injury. 1995; 26(8):543–545. doi: https://doi.org/10.1016/0020-1383(95)00078-N.

Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C: Excess mortality following hip fracture: a systematic epidemiological review. OsteoporosInt 2009 Oct; 20(10):1633-50. doi: https://doi.org/10.1007/s00198-009-0920-3. Epub 2009 May 7.

Roche JJ, Wenn RT, Sahota O, Moran CG: Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 2005 Dec 10; 331(7529):1374. Epub 2005 Nov 18. DOI: https://doi.org/10.1136/bmj.38643.663843.55.

Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J: Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res 2003 Dec; 18(12):2231-7. DOI: https://doi.org/10.1359/jbmr.2003.18.12.2231.

Handoll HH, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ: Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev. 2002 ;( 4):CD000305. DOI: https://doi.org/10.1002/14651858.CD000305.

Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA: Survival after hip fracture. Osteoporos Int. 2005 Dec; 16(12):1583-90. Epub 2005 Oct 11. DOI: https://doi.org/10.1007/s00198-005-2024-z.

Vestergaard P, Rejnmark L, Mosekilde L: Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int 2007 Dec; 18(12):1583-93. DOI: https://doi.org/10.1007/s00198-007-0403-3. Epub 2007 Jun 14.

Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984 Jun; (186):45-56.

Goel SA, Bhavsar NM, Makwana H, Lil NA, Patel PR. Epidemiology and patterns of lower limb injuries at a tertiary care hospital in Ahmedabad. Int J Med Res Rev. 2015; 3(5):490-496. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/267.

Nettleman MD, Alsip J, Schrader M, Schulte M. Predictors of mortality after acute hip fracture. J Gen Intern Med. 1996 Dec; 11(12):765-7.doi: https://doi.org/10.1007/bf02598997.

Dirksen A, Kjoller E. Cardiac predictors of death after non-cardiac surgery evaluated by intention to treat. BMJ 1988 Oct 22; 297(6655):1011-3.

Dyson A, Henderson AM, Chamley D, Campbell ID. An assessment of postoperative oxygen therapy in patients with fractured neck of femur. .Anaesth Intensive Care 1988 Nov; 16(4):405-10.doi: https://doi.org/10.1177/0310057x8801600404.

Juelsgaard P, Sand NP, Felsby S, Dalsgaard J, Jakobsen KB, Brink O, et al. Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia. Eur J Anaesthesiol. 1998 Nov; 15(6):656-63.doi: https://doi.org/10.1097/00003643-199811000-00006.

Khan R, Fernandez C, Kashifl F, Shedden R, Diggory P. Combined orthogeriatric care in the management of hip fractures: a prospective study. Ann R Coll Surg Engl. 2002 Mar; 84(2):122-4.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503781/.

Correlation of preoperative co-morbidities with post-operative outcomes in patients operated for hip fractures
CITATION
DOI: 10.17511/ijmrr.2016.i12.23
Published: 2016-12-31
How to Cite
1.
R Goyal R, Makwana H, M Bhavsar N, A Musa R, R Patel P. Correlation of preoperative co-morbidities with post-operative outcomes in patients operated for hip fractures. Int J Med Res Rev [Internet]. 2016Dec.31 [cited 2021Jun.18];4(12):2217-22. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/791
Section
Original Article