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High short-term and long-term excess mortality in geriatric patients after hip fracture: a prospective cohort study in Taiwan.

Hung LW, Tseng WJ, Huang GS, Lin J - BMC Musculoskelet Disord (2014)

Bottom Line: We recorded data on 55 covariates, including baseline details about health, function, and bone mineral density.Their PARPs were 44.7%, 38.1%, and 34.3%, respectively.Its adequate prevention and treatment should be targeted.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, No,7 Chung-Shan S, Rd, Taipei, Taiwan, 100. jinn@ntu.edu.tw.

ABSTRACT

Background: Hip fracture has a high mortality rate, but the actual level of long-term excess mortality and its impact on population-wide mortality remains controversial. The present prospective study investigated short- and long-term excess mortality after hip fractures with adjustment of other risk factors. We calculated the population attributable risk proportion (PARP) to assess the impact of each risk factor on excess mortality.

Methods: We recruited 217 elders with hip fractures and 215 age- and sex-matched patients without fractures from the geriatric department of the same hospital. The mean follow-up time was 46.1 months (range: 35 to 57 months). We recorded data on 55 covariates, including baseline details about health, function, and bone mineral density. We used the multivariate Cox proportional hazards model to analyze hazard ratios (HRs) of short-term (<12 months follow-up) and long-term (≧ 2 months follow-up) excess mortality for each covariate and calculated their PARP.

Results: Patients with hip fractures had a higher short-term mortality than non-fractured patients, and the long-term excess mortality associated with hip fracture remained high. The significant risk factors for short-term mortality were hip fracture, comorbidities, and lower (below cutoff) Mini Mental State Examination score with HRs of 2.4, 2.3, and 2.3, respectively. Their PARPs were 44.7%, 38.1%, and 34.3%, respectively. The significant risk factors for long-term mortality were hip fracture (HR: 2.7; PARP: 48.0%), lower T-score (HR: 3.3; PARP: 36.2%), lower body mass index (HR: 2.5; PARP: 42.8%), comorbidities (HR: 2.1; PARP: 34.8%), difficulty in activities of daily living (HR: 1.9; PARP: 31.8%), and smoking (HR: 2.5; PARP: 19.2%).

Conclusions: After comprehensive adjustment, hip fracture was a significant risk factor and contributed the most to long-term as well as short-term excess mortality. Its adequate prevention and treatment should be targeted.

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Related in: MedlinePlus

Kaplan-Meier survival curve. Five-year Kaplan-Meier estimates of cumulative probability of survival after hospital admission for hip fracture. Each vertical tick mark indicates a follow-up month in which patient censoring took place.
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Figure 1: Kaplan-Meier survival curve. Five-year Kaplan-Meier estimates of cumulative probability of survival after hospital admission for hip fracture. Each vertical tick mark indicates a follow-up month in which patient censoring took place.

Mentions: During the follow-up, there were 93 (21.5%) deaths for all the enrolled patients. Among them, 75 (34.6%) patients with hip fractures died versus 18 (8.4%) patients without fractures. The Kaplan-Meier survival curve of the hip fracture group declined after the first month of follow-up and significantly diverged from the curve of the non-fracture group (Figure 1). In the short-term mortality study, the overall mortality rate was 8.1%. In the hip fracture group, 12.4% of those patients died versus 3.7% in the non-fracture group (HR 3.5; 95% CI 1.6-7.6).


High short-term and long-term excess mortality in geriatric patients after hip fracture: a prospective cohort study in Taiwan.

Hung LW, Tseng WJ, Huang GS, Lin J - BMC Musculoskelet Disord (2014)

Kaplan-Meier survival curve. Five-year Kaplan-Meier estimates of cumulative probability of survival after hospital admission for hip fracture. Each vertical tick mark indicates a follow-up month in which patient censoring took place.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4020382&req=5

Figure 1: Kaplan-Meier survival curve. Five-year Kaplan-Meier estimates of cumulative probability of survival after hospital admission for hip fracture. Each vertical tick mark indicates a follow-up month in which patient censoring took place.
Mentions: During the follow-up, there were 93 (21.5%) deaths for all the enrolled patients. Among them, 75 (34.6%) patients with hip fractures died versus 18 (8.4%) patients without fractures. The Kaplan-Meier survival curve of the hip fracture group declined after the first month of follow-up and significantly diverged from the curve of the non-fracture group (Figure 1). In the short-term mortality study, the overall mortality rate was 8.1%. In the hip fracture group, 12.4% of those patients died versus 3.7% in the non-fracture group (HR 3.5; 95% CI 1.6-7.6).

Bottom Line: We recorded data on 55 covariates, including baseline details about health, function, and bone mineral density.Their PARPs were 44.7%, 38.1%, and 34.3%, respectively.Its adequate prevention and treatment should be targeted.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, No,7 Chung-Shan S, Rd, Taipei, Taiwan, 100. jinn@ntu.edu.tw.

ABSTRACT

Background: Hip fracture has a high mortality rate, but the actual level of long-term excess mortality and its impact on population-wide mortality remains controversial. The present prospective study investigated short- and long-term excess mortality after hip fractures with adjustment of other risk factors. We calculated the population attributable risk proportion (PARP) to assess the impact of each risk factor on excess mortality.

Methods: We recruited 217 elders with hip fractures and 215 age- and sex-matched patients without fractures from the geriatric department of the same hospital. The mean follow-up time was 46.1 months (range: 35 to 57 months). We recorded data on 55 covariates, including baseline details about health, function, and bone mineral density. We used the multivariate Cox proportional hazards model to analyze hazard ratios (HRs) of short-term (<12 months follow-up) and long-term (≧ 2 months follow-up) excess mortality for each covariate and calculated their PARP.

Results: Patients with hip fractures had a higher short-term mortality than non-fractured patients, and the long-term excess mortality associated with hip fracture remained high. The significant risk factors for short-term mortality were hip fracture, comorbidities, and lower (below cutoff) Mini Mental State Examination score with HRs of 2.4, 2.3, and 2.3, respectively. Their PARPs were 44.7%, 38.1%, and 34.3%, respectively. The significant risk factors for long-term mortality were hip fracture (HR: 2.7; PARP: 48.0%), lower T-score (HR: 3.3; PARP: 36.2%), lower body mass index (HR: 2.5; PARP: 42.8%), comorbidities (HR: 2.1; PARP: 34.8%), difficulty in activities of daily living (HR: 1.9; PARP: 31.8%), and smoking (HR: 2.5; PARP: 19.2%).

Conclusions: After comprehensive adjustment, hip fracture was a significant risk factor and contributed the most to long-term as well as short-term excess mortality. Its adequate prevention and treatment should be targeted.

Show MeSH
Related in: MedlinePlus