Predictors of hip fracture mortality in Ghana: a single-center prospective study

Paa Kwesi Baidoo; James B Odei; Velarie Ansu; Michael Segbefia; Henry Holdbrook-Smith

doi:10.1007/s11657-021-00883-z

Predictors of hip fracture mortality in Ghana: a single-center prospective study

Arch Osteoporos. 2021 Feb 20;16(1):35. doi: 10.1007/s11657-021-00883-z.

Authors

Paa Kwesi Baidoo^{1

2}, James B Odei³, Velarie Ansu⁴, Michael Segbefia⁵, Henry Holdbrook-Smith⁵

Affiliations

¹ Directorate of Orthopedics and Trauma, Komfo Anokye Teaching Hospital, Kumasi, Ghana. pakvandal@gmail.com.
² Orthopedics Unit, Department of Surgery University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana. pakvandal@gmail.com.
³ Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA.
⁴ School of Public Health, Indiana University Bloomington, Bloomington, IN, USA.
⁵ Orthopedics Unit, Department of Surgery University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana.

PMID: 33609199
DOI: 10.1007/s11657-021-00883-z

Abstract

To determine risk factors influencing mortality in patients with proximal femur fractures in a Ghanaian hospital over a 4-year period.

Methods: Incidence of mortality was assessed among 76 participants with proximal femur fractures from January to December 2014 and followed up for 4 years. Outcomes of interest were mortality at 1 month, 6 months, 1 year, and 4 years. Hazard ratios (HRs) were calculated using Cox proportional hazards regression, adjusting for mortality risk factors.

Results: Among the 76 participants (mean age 75.8 years [SD = 12.02], 36 (47.4%) males), there were 21 death cases. The mean time of injury to surgery was 16.4 (SD = 16.2) days. Hip fractures comprised of 38 (50%) intertrochanteric, 35 (46.05%) transcervical, and 3 (3.95%) basicervical. Mortality at 1 month, 6 months, 1 year, and 4 years were 6.6%, 13.2%, 19.7%, and 27.6%, respectively. Multiple regression analysis showed a yearly increase in age that was associated with a 1.03-fold increase in the risk of death (p = 0.17). Comparing males to females, there was a significant difference in mortality (HR = 5.24, p = 0.03). Participants with basicervical hip fracture versus those with transcervical hip fracture were at higher risk of dying (HR = 28.88, p = 0.01). Patients with abnormal/low creatinine as compared to those with normal creatinine were at higher risk of dying (HR = 5.64, p = 0.005). Also, participants with an American Society of Anesthesiologists (ASA) score of III or IV were 2.73 times more likely to experience death than those with an ASA score of I or II (95% CI: 0.93-8.89, p = 0.08). Additionally, a higher risk of death was associated with patients with chronic obstructive pulmonary disease (COPD) (HR = 53.45, p = 0.001) and osteoporosis (HR = 8.75, p = 0.006).

Conclusion: Being male, having basicervical hip fracture, abnormal/low creatinine, and a history of COPD and osteoporosis were the main predictors of mortality in the study population. These findings could serve as a guide when managing patients with proximal femur fractures to improve the outcome.

Keywords: Ghana; Hip fracture; Mortality; Risk factors.

MeSH terms

Aged
Female
Ghana / epidemiology
Hip Fractures*
Humans
Male
Proportional Hazards Models
Prospective Studies
Risk Factors