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Predicting Survival After Hip Fracture

Posted on: 07/30/2008
Even healthy older adults fear a hip fracture. Studies show that up to 33 per cent of older adults with a hip fracture die within a year. What can we do to prevent this level of mortality? The first step is to find out what are the greatest risk factors for hip fracture. Surviving a hip fracture may depend on modifying as many risk factors as possible.

In this study, over 1,100 patients with hip fractures were placed in a computer database for study and comparison. In order to be included, the patient had to be at least 65 years old. Good mental function and the ability to walk independently were required. Each one was still living independently.

Questions were asked to complete a survey of cognitive function. The medical records were reviewed for information on physical health, postoperative complications, and social data (e.g., age, gender, race, marital status). Type of fracture and events leading up to the fracture were also recorded.

Only patients with a femoral neck or intertrochanteric hip fracture were included. Everyone had surgery to repair the fracture. Number and type of complications was added up. Data on the number of patients who survived, the number who died in the hospital, and death rates for up to 10 years were also collected.

The authors report that most of the patients had at least one other major health problem. A history of cancer and the presence of heart disease were the most common. Many had at least three comorbidities (diseases present at the same time).

Complications were common after surgery. Wound infection, pneumonia, heart failure, stroke, heart attack, and blood clot were the most common surgical and medical problems. Almost three percent of the patients died while still in the hospital. Another 12 per cent died in the first year. By the end of 10 years, the death rate was 75 per cent.

One of the tools used to assess risk was the American Society of Anesthesia's (ASA) rating of operative risk. Risk during the surgery and right after was scored based on inpatient comorbidities. The ASA scoring system is well known for its ability to predict mortality.

The authors reported the following as major predictive risk factors for death after hip fracture:
  • age at the time of the injury (between 65 and 84)
  • male gender
  • use of a cane, walker, or other assistive device to walk
  • unable to walk outside the home
  • history of cancer, heart failure, or chronic lung disease
  • major postoperative complication(s)

    Younger patients who are independent ambulators and who do not have other health problems are most likely to survive a hip fracture. There's not much we can do to change or modify age or gender as it relates to hip fracture, survival, and death. But efforts to modify other risk factors in this group are advised.

    Health care professionals can assist in preventing deaths after surgery for hip fractures. Reducing postoperative complications through monitoring is recommended. More intense pre- and post-operative care is required.

    All of this information is useful when counseling patients and their families about the risks and results of hip fracture. Risks persist for up to five years after surgery. So follow-up is important for continued survival. The focus should be on improving the elderly's general health and ability to maintain an independent ambulation (walking) status.

  • References:
    Nader Paksima, D.O., M.P.H., et al. Predictors of Mortality After Hip Fracture. In Bulletin of the NYU Hospital for Joint Diseases. Vol. 66. No. 2. Pp. 111-117.

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