Epidemiology of Hip Fractures in Argentina. Anemia, Prolonged Hospitalization, and ASA Score as Predictive Factors of Morbidity and Mortality in the Analysis of 1000 Patients
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Published:
Feb 14, 2022
Keywords:
hip fracture, anemia, ASA, hospital stay, morbidity, mortality
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Abstract
Background: Hip fractures are associated with a significant impact on morbidity and mortality. The aim of this report was to identify the variables related to the development of complications and mortality after a hip fracture.
Materials and Methods: We carried out a data analysis from the first 1000 hip fracture surveys from the Morbidity and Mortality Committee of the Asociación Argentina de Ortopedia y Traumatología. Through a bivariate analysis and a multivariate regression, the independent variables related to the presentation of complications or death were identified.
Results: Complications were related to pre-operative anemia, delay in surgery, hospital stay, and red blood cell transfusions. In addition, mortality was related to pre-operative anemia, red blood cell transfusions, hospital stay, ASA score, and postoperative complications. Multiple regression analysis revealed anemia and prolonged hospitalization to be significant predictors of complications, while anemia and ASA score were recognized as predictors of mortality.
Conclusion: This study highlights the predictive value of anemia, an ASA III-IV score, and hospital stay in relation to the morbidity and mortality of patients with hip fracture. Various efforts should be made to optimize the condition of these patients and the health system in order to reduce this impact on morbidity and mortality.
Materials and Methods: We carried out a data analysis from the first 1000 hip fracture surveys from the Morbidity and Mortality Committee of the Asociación Argentina de Ortopedia y Traumatología. Through a bivariate analysis and a multivariate regression, the independent variables related to the presentation of complications or death were identified.
Results: Complications were related to pre-operative anemia, delay in surgery, hospital stay, and red blood cell transfusions. In addition, mortality was related to pre-operative anemia, red blood cell transfusions, hospital stay, ASA score, and postoperative complications. Multiple regression analysis revealed anemia and prolonged hospitalization to be significant predictors of complications, while anemia and ASA score were recognized as predictors of mortality.
Conclusion: This study highlights the predictive value of anemia, an ASA III-IV score, and hospital stay in relation to the morbidity and mortality of patients with hip fracture. Various efforts should be made to optimize the condition of these patients and the health system in order to reduce this impact on morbidity and mortality.
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Garabano, G., Simesen de Bielke, H., Cubecino, A., Robador, N. A., Olivetto, J., Gamarra, D., Sierto, M. N., & Beltramino, M. L. (2022). Epidemiology of Hip Fractures in Argentina. Anemia, Prolonged Hospitalization, and ASA Score as Predictive Factors of Morbidity and Mortality in the Analysis of 1000 Patients. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(1), 111-121. https://doi.org/10.15417/issn.1852-7434.2022.87.1.1340
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References
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for mortality in patients with hip fractures. Dan Med J 2013;60(8):1-6. PMID:23905564
2. Rojas Padilla LG, Quintero Hernández S, Jimenez Avila J, Lopez Cervantes RE, Amadei R, Pesciallo C, et al. Hip
fracture care – Latin America. OTA Int 2020;e064. https://doi.org/10.1097/OI9.0000000000000064
3. Abrahamsen B, van Staa T, Ariely R. Excess mortality following hip fractures: a systematic epidemiological review. Osteoporos Int 2009;20(10):1633-50. https://doi.org/10.1007/s00198.009-0920-3
4. Huette P, Abou-Arab O, Djebara AE, Terrasi B, Beyls Ch, Guinot PG, et al. Risk factors and mortality of patients
undergoing hip fracture surgery: a one-year follow-up study. Sci Rep 2020;10(1):9607. https://doi.org/10.1038/s41598-020-66614-5
5. Hailer NP, Garland A, Rogmark C, Garellick G, Karrholm J. Early mortality after total hip arthroplasty in patients
with femoral neck fracture. Acta Orthop 2016;87(6):560-6. https://doi.org/10.1080/17453674.2016.1234869
6. Garabano G, Cubecino A, Simesen de Bielke H, Robador N, Olivetto JM, Sierto M, et al. Epidemiología de la
fractura de cadera en Argentina. Rev Asoc Argent Ortop Traumatol 2020;85(4):437-46. https://doi.org/10.15417/issn.1852-7434.2020.85.4.1113
7. Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: A review. World J Orthop 2014;18-5(4):402-11. https://doi.org/10.5312/wjo.v5.i4.402
8. Potter LJ, Doleman B, Moppett IK. A systematic review of pre-operative anemia and blood transfusion in patients with fractured hips. Anesthesia 2015;70(4):483-500. https://doi.org/10.1111/anae.12978
9. Ryan G, Nowak L, Melo L, Ward S, Atrey A, Schemitsch EH, et al. Anemia at presentation predicts acute mortality and need for readmission following geriatric hip fractures. JB JS Open Access 2020;5(3):e20.00048.
https://doi.org/10.2106/JBJS.OA.20.00048
10. Arshi A, Lai WC, Iglesias BC, McPherson EJ, Zeegen EN, Stavrakis AI, et al. Blood transfusion rates and predictors following geriatric hip fracture surgery. Hip Int 2021;31(2)272-9. https://doi.org/10.1177/1120700019897878
11. Ahman R, Siverhall PF, Snygg J, Fredikson M, Enlund G, Bjornstrom K, et al. Determinants of mortality after hip
fractures surgery in Sweden: a registry-based retrospective cohort study. Sci Rep 2018;8:15695. https://doi.org/10.1038/s41598-018-33940-8
12. Hip Fracture Accelerated Surgical Treatment and Care Track (HIP ATTACK) Investigators. Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial. Can Med Assoc J 2014;186(1):E52-60. https://doi.org/10.1503/cmaj.130901
13. Lewis PM, Wadell J. When is ideal time to operate on a patient with fracture of the hip? A review of the available literature. Bone Joint J 2016;98-B(12):1573-81. https://doi.org/10.1302/0301-620X.98B12.BJJ-2016-0362.R2
14. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients?
Systematic review, Meta-analysis and meta-regression. Can J Anaesth 2008;55(3):146-55. https://doi.org/10.1007/BF03016088
15. Brink O. Hip fracture clearance: how much optimization is necessary? Injury 2020;51(Suppl 2):S111-S117.
https://doi.org/10.1016/j.injury.2020.02.046
16. Noailles T, Brulefert K, Chalopin A, Lonis PM, Gouin F. What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature. Int Orthop 2016;40(9):1843-8. https://doi.org/10.1007/s00264-015-3033-y
17. Liu X, Dong Z, Li J, Cao G, Song X, Yang J. Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study. J Orthop Surg Res 2019;14:382.
https://doi.org/10.1186/s13018-019-1449-6
18. Ji Ch, Zhu Y, Liu S, Li J, Zhang F, Chen W, et al. Incidence and risk of surgical site infection after adult femoral
neck fractures treated by surgery. Medicine 2019;98-11:1-8. https://doi.org/10.1079/MD.0000000000014882
19. Coto LC, Codesido VPI, Perez MB, Mendoza RGA, Thies CO, Blanco AH, et al. Influence of surgical parameters on mortality after surgery for extracapsular hip fractures in the elderly. Rev Esp Cir Ortop Traumatol
2020;65(5):342-9. https://doi.org/10.1016/j.recot.2020.04.003
for mortality in patients with hip fractures. Dan Med J 2013;60(8):1-6. PMID:23905564
2. Rojas Padilla LG, Quintero Hernández S, Jimenez Avila J, Lopez Cervantes RE, Amadei R, Pesciallo C, et al. Hip
fracture care – Latin America. OTA Int 2020;e064. https://doi.org/10.1097/OI9.0000000000000064
3. Abrahamsen B, van Staa T, Ariely R. Excess mortality following hip fractures: a systematic epidemiological review. Osteoporos Int 2009;20(10):1633-50. https://doi.org/10.1007/s00198.009-0920-3
4. Huette P, Abou-Arab O, Djebara AE, Terrasi B, Beyls Ch, Guinot PG, et al. Risk factors and mortality of patients
undergoing hip fracture surgery: a one-year follow-up study. Sci Rep 2020;10(1):9607. https://doi.org/10.1038/s41598-020-66614-5
5. Hailer NP, Garland A, Rogmark C, Garellick G, Karrholm J. Early mortality after total hip arthroplasty in patients
with femoral neck fracture. Acta Orthop 2016;87(6):560-6. https://doi.org/10.1080/17453674.2016.1234869
6. Garabano G, Cubecino A, Simesen de Bielke H, Robador N, Olivetto JM, Sierto M, et al. Epidemiología de la
fractura de cadera en Argentina. Rev Asoc Argent Ortop Traumatol 2020;85(4):437-46. https://doi.org/10.15417/issn.1852-7434.2020.85.4.1113
7. Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: A review. World J Orthop 2014;18-5(4):402-11. https://doi.org/10.5312/wjo.v5.i4.402
8. Potter LJ, Doleman B, Moppett IK. A systematic review of pre-operative anemia and blood transfusion in patients with fractured hips. Anesthesia 2015;70(4):483-500. https://doi.org/10.1111/anae.12978
9. Ryan G, Nowak L, Melo L, Ward S, Atrey A, Schemitsch EH, et al. Anemia at presentation predicts acute mortality and need for readmission following geriatric hip fractures. JB JS Open Access 2020;5(3):e20.00048.
https://doi.org/10.2106/JBJS.OA.20.00048
10. Arshi A, Lai WC, Iglesias BC, McPherson EJ, Zeegen EN, Stavrakis AI, et al. Blood transfusion rates and predictors following geriatric hip fracture surgery. Hip Int 2021;31(2)272-9. https://doi.org/10.1177/1120700019897878
11. Ahman R, Siverhall PF, Snygg J, Fredikson M, Enlund G, Bjornstrom K, et al. Determinants of mortality after hip
fractures surgery in Sweden: a registry-based retrospective cohort study. Sci Rep 2018;8:15695. https://doi.org/10.1038/s41598-018-33940-8
12. Hip Fracture Accelerated Surgical Treatment and Care Track (HIP ATTACK) Investigators. Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial. Can Med Assoc J 2014;186(1):E52-60. https://doi.org/10.1503/cmaj.130901
13. Lewis PM, Wadell J. When is ideal time to operate on a patient with fracture of the hip? A review of the available literature. Bone Joint J 2016;98-B(12):1573-81. https://doi.org/10.1302/0301-620X.98B12.BJJ-2016-0362.R2
14. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients?
Systematic review, Meta-analysis and meta-regression. Can J Anaesth 2008;55(3):146-55. https://doi.org/10.1007/BF03016088
15. Brink O. Hip fracture clearance: how much optimization is necessary? Injury 2020;51(Suppl 2):S111-S117.
https://doi.org/10.1016/j.injury.2020.02.046
16. Noailles T, Brulefert K, Chalopin A, Lonis PM, Gouin F. What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature. Int Orthop 2016;40(9):1843-8. https://doi.org/10.1007/s00264-015-3033-y
17. Liu X, Dong Z, Li J, Cao G, Song X, Yang J. Factors affecting the incidence of surgical site infection after geriatric hip fracture surgery: a retrospective multicenter study. J Orthop Surg Res 2019;14:382.
https://doi.org/10.1186/s13018-019-1449-6
18. Ji Ch, Zhu Y, Liu S, Li J, Zhang F, Chen W, et al. Incidence and risk of surgical site infection after adult femoral
neck fractures treated by surgery. Medicine 2019;98-11:1-8. https://doi.org/10.1079/MD.0000000000014882
19. Coto LC, Codesido VPI, Perez MB, Mendoza RGA, Thies CO, Blanco AH, et al. Influence of surgical parameters on mortality after surgery for extracapsular hip fractures in the elderly. Rev Esp Cir Ortop Traumatol
2020;65(5):342-9. https://doi.org/10.1016/j.recot.2020.04.003