Background and Goal of Study: Hip fractures have a high 30 days postoperative mortality. The aim of the study was to determine predictors of mortality in the population with Femoral Neck Fractures (FNF) submitted to surgical treatment.
Materials and Methods: Retrospective study of patients admitted for surgical treatment of FNF between Jan 2007 and Jun 2008. Patient characteristics, anesthesia, surgical technique, complications and length of stay in hospital (LOSH) were evaluated. Cardiac disease includes heart failure, valvular disease, ischemic heart disease, and arrhythmia. Pulmonary disease includes obstructive and restrictive affections. Statistic associations performed with Chi-square or Fisher's exact test.
Results and Discussion: 298 patients were reviewed and 284 met the inclusion criteria.
The variables found to be independent predictors of mortality were: age > 85 years (67% vs 39%; p=0,031), cardiac disease (87% vs 42%; p< 0,01), chronic renal failure (53% vs 14%; p= 0.001), more than 3 co-morbidities (60% vs 29%; p= 0.02), ASA physical status III/IV (73% vs 46%; p=0.02), intraoperative blood transfusion (53% vs 26%; p=0.032), arthroplasty as surgical technique compared to osteosynthesis (60% vs 28%; p=0.017) and postoperative complications (53% vs 12%; p< 0.001).
There was no statistically significant association between mortality and: gender (p=0.574), anemia -Hb< 10 g dl/L- (20% vs 11%; p=0,232), time to surgery >=3 days (60% vs 36%; p=0.062), regional anesthesia as anesthesic technique compared to general anesthesia (73% vs 81%; p= 0.506), remain co-morbidities: [arterial hypertension (60% vs 51%; p=0,494), respiratory disease (33% vs 18%; p= 0.173), stroke (27% vs 25%; p=0.767), diabetes mellitus (33% vs 26%; p=0,552), domiciliary anticoagulation therapy (7% vs 16%; p=0.479)], ICU admission (7% vs 2%; p=0.319) and LOSH > 14 days (47% vs 30%; p=0.248).
Conclusion: According to our results, the predictors of mortality in femoral neck fractures treated surgically are: cardiac disease, chronic renal failure, ASA physical status III/IV, intraoperative blood products, arthroplasty and postoperative complications.
M. J. Maxwell, Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery; BJA 101 (4):511-17 (2008)