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Mortality and complications after hip fracture among elderly patients undergoing hemodialysis.

Lin JC, Liang WM - BMC Nephrol (2015)

Bottom Line: We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate.We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival.The cumulative incidence of the first complication was estimated using competing risk analysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Statistics, National Taipei University, Taipei, Taiwan. cflin.ntpu@gmail.com.

ABSTRACT

Background: Osteoporotic hip fractures cause high mortality and morbidity in elderly adults. Compared to the general population, subjects with end-stage renal disease and hemodialysis often develop mineral bone disorders and have a higher risk for hip fractures.

Methods: We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate. Subjects aged greater than 60 years with hip fracture were selected from Taiwan's National Health Insurance Research Database covering a period from 1997 to 2007, and these subjects were followed up until 2009. We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival. The cumulative incidence of the first complication was estimated using competing risk analysis.

Results: Among hemodialysis subjects, the three-month, one-year, two-year and five-year mortality rates were 17.3 %, 37.2 %, 51.5 %, and 80.5 %, respectively; the one-year and five-year cumulative incidences of the first surgical complication were 14.2 % and 20.6 %, respectively; and the three-month cumulative incidence of the first medical complication was 24.1 %. Hemodialysis subjects presented a 2.32 times (95 % CI: 2.16-2.49) higher hazard ratio of overall death, 1.15 times (95 % CI: 1.01-1.30) higher sub-hazard ratio (sub-HR) of surgical complications, and 1.35 times (95 % CI: 1.21-1.52) higher sub-HR of the first medical complication than non-hemodialysis controls.

Conclusions: The overall mortality and complication rates of hemodialysis subjects after surgery for hip fracture were significantly higher than those of non-hemodialysis subjects. Further prospective studies which include important risk factors are necessary to more precisely quantify the adjusted effect of hemodialysis.

No MeSH data available.


Related in: MedlinePlus

Ten-year cumulative curves of (a) mortality stratified by age, (b) first surgical complication stratified by age, (c) three-month cumulative curves of first medical complication stratified by age
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Fig1: Ten-year cumulative curves of (a) mortality stratified by age, (b) first surgical complication stratified by age, (c) three-month cumulative curves of first medical complication stratified by age

Mentions: Between 1997 and 2007, 2680 hip fracture subjects with hemodialysis and 2680 matched controls without hemodialysis were identified, of which 63.4 % were female, 36.6 % were male, 56.8 % had cervical fractures, 43.2 % had trochanteric fracture, 53.3 % received internal fixation, and 46.7 % received hemiarthroplasty (Table 1). The death incidence rate was 354.30 per 1000 person-year (PY) (95 % CI: 339.49–369.75) for hemodialysis patients, and 152.04 per 1000 PY (95 % CI: 144.52–159.95) for non-hemodialysis patients. The median survival time was 1.89 years (95 % CI: 1.76–2.03) for hemodialysis, and 4.68 years (95 % CI: 4.42–4.98) for non-hemodialysis subjects. The one-month to ten-year mortality rates and cumulative incidence rates of the first complication are shown in Table 2 and Fig. 1. The two-year and five-year mortality rates were 51.5 % and 80.5 % for hemodialysis and 25.9 % and 52.3 % for non-hemodialysis subjects, respectively. Hemodialysis subjects after surgery for hip fracture had significantly higher overall mortality and complication rates than non-hemodialysis subjects after surgery for hip fracture.Table 1


Mortality and complications after hip fracture among elderly patients undergoing hemodialysis.

Lin JC, Liang WM - BMC Nephrol (2015)

Ten-year cumulative curves of (a) mortality stratified by age, (b) first surgical complication stratified by age, (c) three-month cumulative curves of first medical complication stratified by age
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4492013&req=5

Fig1: Ten-year cumulative curves of (a) mortality stratified by age, (b) first surgical complication stratified by age, (c) three-month cumulative curves of first medical complication stratified by age
Mentions: Between 1997 and 2007, 2680 hip fracture subjects with hemodialysis and 2680 matched controls without hemodialysis were identified, of which 63.4 % were female, 36.6 % were male, 56.8 % had cervical fractures, 43.2 % had trochanteric fracture, 53.3 % received internal fixation, and 46.7 % received hemiarthroplasty (Table 1). The death incidence rate was 354.30 per 1000 person-year (PY) (95 % CI: 339.49–369.75) for hemodialysis patients, and 152.04 per 1000 PY (95 % CI: 144.52–159.95) for non-hemodialysis patients. The median survival time was 1.89 years (95 % CI: 1.76–2.03) for hemodialysis, and 4.68 years (95 % CI: 4.42–4.98) for non-hemodialysis subjects. The one-month to ten-year mortality rates and cumulative incidence rates of the first complication are shown in Table 2 and Fig. 1. The two-year and five-year mortality rates were 51.5 % and 80.5 % for hemodialysis and 25.9 % and 52.3 % for non-hemodialysis subjects, respectively. Hemodialysis subjects after surgery for hip fracture had significantly higher overall mortality and complication rates than non-hemodialysis subjects after surgery for hip fracture.Table 1

Bottom Line: We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate.We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival.The cumulative incidence of the first complication was estimated using competing risk analysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Statistics, National Taipei University, Taipei, Taiwan. cflin.ntpu@gmail.com.

ABSTRACT

Background: Osteoporotic hip fractures cause high mortality and morbidity in elderly adults. Compared to the general population, subjects with end-stage renal disease and hemodialysis often develop mineral bone disorders and have a higher risk for hip fractures.

Methods: We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate. Subjects aged greater than 60 years with hip fracture were selected from Taiwan's National Health Insurance Research Database covering a period from 1997 to 2007, and these subjects were followed up until 2009. We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival. The cumulative incidence of the first complication was estimated using competing risk analysis.

Results: Among hemodialysis subjects, the three-month, one-year, two-year and five-year mortality rates were 17.3 %, 37.2 %, 51.5 %, and 80.5 %, respectively; the one-year and five-year cumulative incidences of the first surgical complication were 14.2 % and 20.6 %, respectively; and the three-month cumulative incidence of the first medical complication was 24.1 %. Hemodialysis subjects presented a 2.32 times (95 % CI: 2.16-2.49) higher hazard ratio of overall death, 1.15 times (95 % CI: 1.01-1.30) higher sub-hazard ratio (sub-HR) of surgical complications, and 1.35 times (95 % CI: 1.21-1.52) higher sub-HR of the first medical complication than non-hemodialysis controls.

Conclusions: The overall mortality and complication rates of hemodialysis subjects after surgery for hip fracture were significantly higher than those of non-hemodialysis subjects. Further prospective studies which include important risk factors are necessary to more precisely quantify the adjusted effect of hemodialysis.

No MeSH data available.


Related in: MedlinePlus