Causes and risks of in-hospital death in geriatric patients with hip fracture / 中华创伤骨科杂志

ABSTRACT

Objective:To analyze the causes and risks of in-hospital death in geriatric patients with hip fracture.Methods:Retrospectively analyzed were the data of 1,878 elderly patients with hip fracture who had been admitted to Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from May 2015 to December 2017. There were 543 males and 1,335 females, with a male-to-female ratio of 1∶2.5 and a mean age of 79.6 years (from 65 to 105 years). There were 988 (52.6%) femoral neck fractures, 850 (45.3%) intertrochanteric fractures, and 40 (2.1%) femoral subtrochanteric fractures. 94.8% of the patients (1,781/1,878) received surgery. Cases of in-hospital death were recorded and their causes analyzed. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) and the Nottingham Hip Fracture Score (NHFS) were used to assess the in-hospital deaths. The accuracy of these 2 assessment tools was validated on a small scale.Results:Thirteen in-hospital deaths were recorded, giving an in-hospital mortality of 0.69% (13/1,878). The direct causes of death were pulmonary infection in 7 cases, acute myocardial infarction in 2 cases, acute erosive hemorrhagic gastritis in 2 cases, acute respiratory distress syndrome in one, and suspected acute pulmonary embolism in one. Thirteen patients died, yielding a rate of in-hospital death of 5.3%±2.8% by E-PASS and that of 9.3%±4.0% by NHFS which were statistically different ( t=2.596, P=0.023). Conclusions:As geriatric patients with hip fracture are at a high risk of perioperative pulmonary infection, vigilance and early prevention are required during treatment. Care should be taken to monitor cardiovascular events and blood glucose, and stress ulcers should be prevented. The NHFS is recommended to assess the risks of in-hospital death in geriatric patients with hip fracture.