Early mortality after hip fracture: what matters?

Emilija Dubljanin Raspopovic; Ljiljana Markovic Denic; Jelena Marinkovic; Kristina Radinovic; Nela Ilić; Sanja Tomanović Vujadinović; Marko Kadija

doi:10.1111/psyg.12076

Early mortality after hip fracture: what matters?

Psychogeriatrics. 2015 Jun;15(2):95-101. doi: 10.1111/psyg.12076. Epub 2014 Dec 17.

Authors

Emilija Dubljanin Raspopovic^{1

2}, Ljiljana Markovic Denic^{1

3}, Jelena Marinkovic^{1

4}, Kristina Radinovic⁵, Nela Ilić^{1

2}, Sanja Tomanović Vujadinović^{1

2}, Marko Kadija^{1

6}

Affiliations

¹ Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
² Clinic for Physical Medicine and Rehabilitation, Clinical Center Serbia, Belgrade, Serbia.
³ Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁴ Institute of Medical Statistics and Medical Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Institute of Anesthesia and Reanimation, Clinical Center Serbia, Belgrade, Serbia.
⁶ Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia, Belgrade, Serbia.

PMID: 25516204
DOI: 10.1111/psyg.12076

Abstract

Background: Hip fractures in the elderly are followed by increased mortality, which is highest in the period immediately after the fracture. Predictors for early mortality have neither been well identified nor summarized. Identification of early postoperative mortality predictors enables the stratification of high-risk patients and can help in the development of strategies aimed at reducing risk and improving outcome after hip fracture. The primary aim of this study was to investigate the incidence of 30-day mortality. The secondary aim was to investigate factors related to early mortality.

Methods: We examined 384 elderly patients with hip fracture. Multivariate logistic regression analysis was used to explore independent prognostic factors for 30-day mortality.

Results: By the end of the 30-day follow-up period, 22 patients (6.4%) had died. Postoperative delirium was the only variable independently related to 30-day mortality after hip fracture. Older, male patients with a lower cognitive status had a higher chance of developing postoperative delirium.

Discussion: Postoperative delirium is a strong independent marker of high risk for 30-day mortality. Older, male patients with more severe cognitive impairment are at increased risk of developing postoperative delirium. Identifying patients at risk for developing postoperative delirium upon admission and early detection of delirium enable the development of targeted prevention and intervention strategies in older patients with hip fracture.

Keywords: cognitive impairment; delirium; hip fracture; mortality; risk factors.