Mortality rates for hip fracture patients managed surgically and conservatively in a dedicated unit in Singapore

Cheryl Marise Peilin Tan; Derek Howard Park; Ying Dong Chen; Mallya Ullal Jagadish; Su Su; Antony Xavier Rex Premchand

doi:10.1007/s00402-020-03605-1

Mortality rates for hip fracture patients managed surgically and conservatively in a dedicated unit in Singapore

Arch Orthop Trauma Surg. 2022 Jan;142(1):99-104. doi: 10.1007/s00402-020-03605-1. Epub 2020 Sep 18.

Authors

Cheryl Marise Peilin Tan¹, Derek Howard Park², Ying Dong Chen², Mallya Ullal Jagadish³, Su Su³, Antony Xavier Rex Premchand²

Affiliations

¹ Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore. cherylfrancescatan@gmail.com.
² Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
³ Department of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.

PMID: 32945956
DOI: 10.1007/s00402-020-03605-1

Abstract

Introduction: At our hospital, an unusually high proportion of patients and families opted for conservative management of hip fractures. This study aimed to compare the mortality rates of patients with hip fractures treated conservatively to that of operatively managed patients in a dedicated hip fracture unit.

Materials and methods: Retrospective analysis was done for patients who were treated for hip fractures between January 2015 and October 2017 in a Hip Fracture Unit at a tertiary hospital. Patients were managed non-operatively or surgically after discussion with the multi-disciplinary team.

Results: 233 patients were treated conservatively and 781 underwent operative management for hip fractures. Patients managed non-operatively had a higher inpatient, 30-day and 1-year mortality rates. Inpatient mortality was 6.01% for conservatively managed compared to 0% for operative management. 30-day mortality for conservatively managed patients was 8.58% as compared to 0% for operatively managed patients, and 1-year mortality was 33.05% as opposed to 8.96%. There was an association seen with the type of management of hip fractures and that of inpatient death (p = 0.000), death in 30 days (p = 0.000) and death in 1 year (p = 0.000). The type of management was a predictive factor in 1-year mortality (p = 0.000). The average number of co-morbidities in conservatively managed patients was 5.2 compared to surgically managed patients of 4.0. Conservatively managed hip patients had a higher prevalence of stroke, chronic kidney disease and ischemic heart disease. Complications during hospital stay were comparable for both groups. The mean length of hospital stay was similar for both groups.

Conclusion: Surgical intervention for hip fractures is associated with lower inpatient, 30-day and 1-year mortality rates. However, patient co-morbidities and pre-morbid conditions should also be considered.

Level of evidence: IV.

Keywords: Conservative management; Hip fractures; Mortality rates; Multidisciplinary care.

MeSH terms

Conservative Treatment
Hip Fractures* / surgery
Humans
Length of Stay
Retrospective Studies
Singapore / epidemiology