Predictors and prognosis of elderly hip fracture patients with perioperative atrial fibrillation: a nested case-control study

Wei Li; Aoying Min; Wei Zhao; Weining Li; Shuhan Li; Saidi Ran; Mingming Fu; Qili Yu; Junkai Kou; Zhiqian Wang; Zhiyong Hou

doi:10.1186/s12877-024-05647-1

Predictors and prognosis of elderly hip fracture patients with perioperative atrial fibrillation: a nested case-control study

BMC Geriatr. 2025 Jan 3;25(1):4. doi: 10.1186/s12877-024-05647-1.

Authors

Wei Li^#¹, Aoying Min^#¹, Wei Zhao^#¹, Weining Li², Shuhan Li², Saidi Ran¹, Mingming Fu¹, Qili Yu¹, Junkai Kou¹, Zhiqian Wang³, Zhiyong Hou^{4

5}

Affiliations

¹ Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, Hebei, 050051, PR China.
² Department of Nursing, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, 050051, Hebei, PR China.
³ Department of Geriatric Orthopedics, The Third Hospital of Hebei Medical University, No.139 ZiQiang Lu, Shijiazhuang, Hebei, 050051, PR China. 37800709@hebmu.edu.cn.
⁴ Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, Hebei, 050051, PR China. drzyhou@hebmu.edu.cn.
⁵ NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, No.139, ZiQiang Lu, Shijiazhuang, People's Republic of China. drzyhou@hebmu.edu.cn.

^# Contributed equally.

Abstract

Background: A scarcity of data exists concerning atrial fibrillation (AF) during the perioperative stage of non-cardiothoracic surgery, particularly orthopedic surgery. In addition, given the frequency and significant impact of AF in the perioperative period, therefore our aim was to identify prognosis and predictors of elderly hip fracture patients with perioperative AF.

Methods: An examination of hip fracture patients at the Third Hospital of Hebei Medical University, who had been hospitalized from January 2018 to October 2020 in succession, was conducted retrospectively. To determine independent risk factors for paroxysmal AF in elderly hip fracture patients, univariate and multivariate logistic regression analysis were employed. The Kaplan-Meier survival curve demonstrated the correlation between all-cause mortality in the non-AF, paroxysmal AF, and permanent AF groups. An assessment of the correlation between baseline factors, complications, and all-cause mortality was conducted through univariable and multivariable Cox proportional hazards analysis.

Results: Enrolling 1,376 elderly patients with hip fractures, we found 1,189 in the non-AF group, 103 in the paroxysmal AF group, and 84 in the permanent AF group. Kaplan-Meier survival curves revealed a significantly lower overall survival rate in elderly hip fracture patients with AF, especially permanent AF. Based on COX regression analysis, we found that the main risk factors for all-cause death in elderly hip fracture patients with AF were concomitant pulmonary infection(HR 2.006,95%CI 1.019-3.949, P = 0.044), hyponatremia(HR 2.417,95%CI 1.177-4.961, P = 0.016), permanent AF(HR 2.806, 95%CI 1.036-4.198, P = 0.039). Independent risk factors for perioperative paroxysmal AF in elderly hip fracture patients were hypertension(OR 2.248, 95% CI 1.415-3.571, P = 0.001), COPD(OR 4.694, 95% CI 2.207-9.980, P < 0.001) and ACCI(OR 1.436, 95%CI 1.072-1.924, P = 0.015).

Conclusions: The mortality risk is high in elderly patients with hip fractures combined with AF. The independent risk factors for their death include permanent AF, pulmonary infection and hyponatremia. The independent risk factors for perioperative paroxysmal AF in elderly patients with hip fractures are ACCI, hypertension and COPD. we should identify risk factors and optimize the treatment plan at an early stage.

Keywords: Elderly; Hip fracture; Non- atrial fibrillation; Paroxysmal atrial fibrillation; Permanent atrial fibrillation; Prognosis; Risk factors.