Fat Embolism Syndrome and in-Hospital Mortality Rates According to Patient Age: A Large Nationwide Retrospective Study

Sung Huang Laurent Tsai; Chien-Hao Chen; Eric H Tischler; Shyam J Kurian; Tung-Yi Lin; Chun-Yi Su; Greg Michael Osgood; Amber Mehmood; Tsai-Sheng Fu

doi:10.2147/CLEP.S371670

Fat Embolism Syndrome and in-Hospital Mortality Rates According to Patient Age: A Large Nationwide Retrospective Study

Clin Epidemiol. 2022 Aug 19:14:985-996. doi: 10.2147/CLEP.S371670. eCollection 2022.

Authors

Sung Huang Laurent Tsai^{1

2

3}, Chien-Hao Chen^{1

2}, Eric H Tischler^{3

4}, Shyam J Kurian⁵, Tung-Yi Lin^{1

2}, Chun-Yi Su^{1

2}, Greg Michael Osgood^{3

5}, Amber Mehmood⁶, Tsai-Sheng Fu^{2

7}

Affiliations

¹ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung, 204, Taiwan.
² School of medicine, Chang Gung University, Taoyuan, 333, Taiwan.
³ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
⁵ Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
⁶ University of South Florida College of Public Health,Tampa, FL, USA.
⁷ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.

Abstract

Introduction: Fat embolism syndrome (FES) is a rare life-threatening condition that can develop after traumatic orthopedic injuries. Controversy remains concerning the epidemiology in the elderly population. Therefore, this study aims to report FES related to in-hospital mortality stratified by age.

Methods: A retrospective trauma cohort study was conducted using data from the National Trauma Data Bank (NTDB) from 2007 to 2014. All FES cases were included in the study with the diagnosis of FES (ICD9 958.1). Death on arrival cases were excluded. Patients were stratified by age cohort: less than 40 (G1), 40-64 (G2), and greater than 65 (G3) years of age. The primary outcome evaluated was in-hospital mortality. Multivariable regression models were performed to adjust for potential confounders.

Results: Between 2007 and 2014, 451 people from a total of 5,836,499 trauma patients in the NTDB met the inclusion criteria. The incidence rate was 8 out of 100,000. The inpatient mortality rate was 11.8% for all subjects with the highest mortality rate of 17.6% in patients over 65. Multivariable analyses demonstrated that age greater than 65 years was an independent predictor of mortality (aOR 24.16, 95% CI 3.73, 156.59, p=0.001), despite higher incidence and injury severity of FES among patients less than 40. No significant association with length of hospital stay, length of intensive unit care, or length of ventilation use was found between the groups. Subgroup analysis of the elderly population also showed a higher mortality rate for FES in femoral neck fracture patients (18%) than other femoral fractures (14%).

Conclusion: In this retrospective cohort analysis, old age (≥ 65 years) was found to be an independent risk factor for in-hospital mortality among fat embolism syndrome patients. Elderly patients specifically with femoral neck fractures should be monitored for the development of FES.

Keywords: age; database; fat embolism; mortality; trauma.