Objective: To determine the mortality risk following hip fracture and identify factors predictive of increased mortality.
Design: Retrospective review of prospectively collected data.
Setting: Tertiary care orthopaedic hospital.
Background: Approximately 250,000 hip fractures occur annually in the United States. The greatest mortality risk following hip fracture has been demonstrated to be within the first 6 months of fracture, and some studies report that the risk approaches expected mortality after 6 months. However, more recent studies have demonstrated that an increased risk of mortality may persist for several years postfracture. The purpose of this study was to assess the excess mortality associated with hip fracture at up to 2 years postinjury.
Methods: All patients with a hip fracture who were admitted to our institution over a 10-year period were evaluated. Criteria for inclusion included: Caucasian, age 65 or older, previously ambulatory, and home dwelling. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a 2-year follow-up period. Mortality was compared to a standardized population and standardized mortality ratios were calculated.
Results: Eight hundred thirty-six patients met the inclusion criteria and were included. The mortality risk was highest within the first 3 months following fracture, with standardized mortality ratios approaching that of the control population by two years. Patients age 65–84 had higher mortality risk when compared with patients age ≥85. American Society of Anesthesiologists classification was predictive of increased mortality risk in younger patients, with these patients having triple the mortality risk when compared to the reference population at 2-year follow-up. More elderly patients had minimal excess mortality associated with hip fracture at 1- and 2-year follow-up, regardless of ASA classification.
Conclusion: The data demonstrate that hip fracture is not associated with significant excess mortality amongst patients older than age 85. Amongst younger patients, however, those with ASA classifications of 3 or 4 have significant excess mortality following hip fracture that persists up to 2 years after injury.
Geriatric Hip Fracture Research Group, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, NY, U.S.A.
Accepted April 17, 2002.
Address correspondence and reprint requests to Dr. Kenneth Koval, Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, U.S.A.
No financial support for this project has occurred. The authors have received nothing of value.
This manuscript does not contain information about medical devices.