Espinosa KA, et al. - Researchers investigated the pre-operative factors related to increased mortality in elderly patients with hip fractures in a developing country during the first post-operative year. The factors that were associated with increased mortality included surgical delay greater than 4 days and Charlson Comorbidity Index ≥ 3, along with anaemia < 10 g/dl and age ≥ 80 years. Although a surgical delay of 8.8 days was reported, the mortality rate was similar to that reported by the literature.

Methods

• In this ambidirectional cohort study, patients ≥ 65 years of age who underwent hip surgery due to a hip fracture caused by a fall from a standing position were included.
• The Charlson Comorbidity Index (CCI)-measured socio-demographic data, time to surgery, and comorbidities were recorded.
• The primary outcome was one-year mortality from all causes.
• The secondary outcomes were 30-day and 6-month mortality.
• Using log-rank test and Cox’s proportional hazard regression, survival was assessed and the factors associated with increased mortality were determined, respectively.

Results

• Study included 478 patients who underwent hip surgery, with mean age 80.2 ± 9.9, and 297 (62%) were females.
• At the end of the first follow-up year, 150 (31.4%) deaths were reported, and the mean of surgical delay was 8.8 days ± 6.4.
• Relative to mortality (52%) of patients with a CCI ≥ 3 and surgical delay > 4 days, better survival (90%) was demonstrated by patients who underwent surgery during the first 4 days (Log-rank test < 0.001) after hip fracture occurred and patients with a CCI ≤ 2 (Log-rank test < 0.001).
• The following were found to be related to increased 1-year mortality: age ≥ 80 years (Hazard ratio 2.55 (HR), 95% confidence interval (CI) 1.70 to 3.84, p < 0.001), CCI ≥ 3 (HR 1.61, 95% CI 1.14–2.26, p 0.006), surgical delay > 4 days (HR 2.41, 95% CI 1.38–4.21, p 0.006), and haemoglobin < 10 g/dl (HR 1.51, 95% CI 1.06–2.15, p 0.02).
• Association of 30-day mortality with age ≥ 80 years (HR 4.15, 95% CI 1.98–8.70, p < 0.001), CCI ≥ 3 (HR 1.80, 95% CI 1.08–2.99, p 0.023), pre-surgical time >48 h (HR 3.0, 95% CI 1.58–5.92, p 0.001), and surgical delay > 4 days (HR 3.0, 95% CI 1.33–6.81, p 0.008) was noted; and 6-month mortality was found to be related to surgical delay > 4 days (HR 2.72, 95% CI 1.42–5.23, p 0.003), and haemoglobin < 10 g/dl (HR 1.56, 95% CI 1.04–2.33, p < 0.028).