Chest infection, cardiac failure top list of deaths following hip fractures

Alice Tsai

Chest infections, cardiac failure and sepsis top the list of causes of death after fragility hip fractures, according to a study presented by Alice Tsai at the 12th EFORT Congress 2011.

Tsai and her colleagues wanted to know what was leading to the death of their patients after hip fractures.

“We know that the hip fracture has a high mortality and in the U.K., the incidence of hip fractures rises daily,” Tsai said.

According to Tsai, in the United Kingdom alone, there are more than 300,000 patients admitted to hospitals with hip fractures and studies predict in 10 years that number will increase to 100,000 patients.

Retrospective study

The researchers conducted a retrospective study spanning from 2006 to 2010 of 82 of 648 patients with hip fractures who died. There were 49 female patients and 33 male patients at a ratio of 1.5:1. The patients had a mean age of 87.8 years.

The investigators organized the patients into groups based on organ system including the cardiovascular, respiratory, renal, gastrointestinal, neurological and musculoskeletal systems. The orthopedists measured mortality at 30 days and overall mortality.

Causes of death

Most patients died within the first 30 days of admission. The 30-day mortality rate was 9.4% and the overall mortality rate was 13.6%. Of the 82 patients, 67 died postoperatively and 15 died preoperatively.

The main pathologies that caused postoperative death involved the respiratory system at 59.7%, the cardiac system at 29.9% or the septic system at 35.8%. The top postoperative respiratory cause of death was chest infection, the top cardiac cause of death was pulmonary edema and the top septic, chest infection.

Among septic causes of death, chest infection, urinary trat infection and Clostridium difficile were the main culprits.

The main cause of death preoperatively was respiratory-related. The top respiratory cause of death was chest infection at 81.8% of patients.

“We may assume that the people who are susceptible to death after fracture neck of femur may have multiple pathologies going on that led to death, but in fact, the people that died were found to have only 1 or 2 pathologies,” Tsai said. “So in other words, a simple pneumonia with a background of a frail patient with comorbidities is serious enough to cause death.”

Overall results

Overall, the deaths related to hip fracture were chest infection at 54.9%, cardiac failure at 15.9% or sepsis secondary to chest infection at 32.9% with 62.9% related to chest infection.

“We found that chest infection and cardiac failure in the background of cardiac comorbidities were the main leading causes of death,” Tsai said.

Recommendations

Tsai and her team recommend early input of the medical and geriatric team to reverse or optimize hip fracture-related deaths. Tsai and her colleagues’ affiliated hospital, University Hospitals Bristol in the United Kingdom, has implemented new protocols as a result of this study, including: a fracture neck of femur bay with regular input from ortho-geriatricians, an admission performa incorporating national guidelines and classes for teaching physicians involved on the frontlines of chest infection and heart failure.

“Hopefully, we will be able to come back and present to you the consequences of our implementation,” Tsai said.

Reference:

• Yousri T, Tsai A, Thyagarajen D, Livingstone J, et al. Medical causes of death in hip fragility fractures: Mortality analysis in a primary care trauma centre. Paper #3160. Presented at 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.