Perioperative atrial fibrillation is associated with increased one-year mortality in elderly patients after repair of hip fracture

Abstract

Background: Hip fracture repair is commonly performed in elderly adults and is associated with high mortality. Limited data address the significance of perioperative atrial fibrillation (AF) and its subsequent treatment in emergent orthopedic surgery in the elderly. This study aimed to determine whether newly diagnosed AF among patients initially in sinus rhythm undergoing hip fracture repair is predictive of one-year mortality and whether medical therapy of AF attenuated this finding.

Methods: All patients over the age of 65 who underwent repair of hip fracture in our institution were retrospectively identified. Potential subjects with chronic atrial fibrillation were excluded. 410 subjects were identified and were eligible. The primary endpoint was one year mortality from the date of surgery.

Results: Of the 410 subjects 15 (3.7%) developed AF during hospitalization and 395 (96.3%) did not. Only a previous history of AF and current use of beta blockers were predictive of the development of AF following hip surgery. Mortality among patients with new onset AF was significantly higher than in patients without AF (60% vs 19.5%; p 0.001). Chronic treatment with anti-arrhythmic therapy as well as treatment with anticoagulation were also associated with one-year mortality. On multivariable analysis, AF during hospitalization was the variable most significantly associated with mortality (hazard ratio 6.7 95% CI 2.1-21.4).

Conclusions: One-year mortality in elderly patients undergoing hip fracture repair is significantly increased in patients with postoperative AF. This association did not appear to be attenuated by medical treatment of the AF with anti-arrhythmic therapy.

Keywords: Atrial fibrillation; Elderly; Hip fracture.