Evaluating the Severity Spectrum: A Hierarchical Analysis of Complications during Hip Fracture Admission Associated with Mortality

Christopher J Pettit; Carolyn F Herbosa; Abhishek Ganta; Steven Rivero; Nirmal Tejwani; Philipp Leucht; Sanjit R Konda; Kenneth A Egol

doi:10.1097/BOT.0000000000002909

Evaluating the Severity Spectrum: A Hierarchical Analysis of Complications during Hip Fracture Admission Associated with Mortality

J Orthop Trauma. 2024 Aug 27. doi: 10.1097/BOT.0000000000002909. Online ahead of print.

Authors

Christopher J Pettit¹, Carolyn F Herbosa¹, Abhishek Ganta^{1

2}, Steven Rivero¹, Nirmal Tejwani¹, Philipp Leucht¹, Sanjit R Konda^{1

2}, Kenneth A Egol^{1

2}

Affiliations

¹ Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.
² Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY.

PMID: 39207724
DOI: 10.1097/BOT.0000000000002909

Abstract

Objectives: To determine which in-hospital complications following the operative treatment of hip fractures are associated with increased inpatient, 30-day and 1 year mortality.

Methods: Design: Retrospective study.

Setting: A single academic medical center and a Level 1 Trauma Center.

Patient selection criteria: All patients who were operatively treated for hip fractures (OTA/AO 31A, 31B and Vancouver A,B, and C periprosthetic fractures) at a single center between October, 2014 and June, 2023.

Outcome measures and comparisons: Occurrence of an in-hospital complication was recorded. Cohorts were based upon mortality time points (during admission, 30-days and 1-year) and compared to patients who were alive at those time points to determine which in- hospital complications were most associated with mortality. Correlation analysis was performed between patients who died and those who were alive at each time point.

Results: A total of 3,134 patients (average age of 79.6 years, range 18-104 years and 66.6% female) met inclusion for this study. The overall mortality rate during admission, 30 days and 1 year were found to be 1.6%, 3.9% and 11.1%, respectively. Sepsis was the complication most associated with increased in-hospital mortality (OR: 7.79, 95% CI 3.22 - 18.82, p<0.001) compared to other in-hospital complications. Compared to other in-hospital complications, stroke was the complication most associated with 30-day mortality (OR: 7.95, 95% CI 1.82 - 34.68, p<0.001). Myocardial infarction was the complication most associated with 1-year mortality (OR: 2.86, 95% CI 1.21 - 6.77, p=0.017) compared to other in-hospital complications.

Conclusions: Post-operative sepsis, stroke and myocardial infraction were the three complications most associated with mortality during admission, 30-day mortality and 1-year mortality, respectively, during the operative treatment of hip fractures.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.