The Characterization of Risk Factors Associated with Complications following Intertrochanteric Hip Fractures Surgery
Abstract
Introduction and Objective. Intertrochanteric hip fractures are one of the more common hip fractures experienced, and they are associated with a higher mortality than femoral neck fractures. We aimed to assess which patient characteristics were associated with a higher incidence of postoperative complications and mortality in adults undergoing intertrochanteric hip fracture repair. Methods. A retrospective cohort study of adults who underwent intertrochanteric hip fractures was identified using the 2017-2020 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients were excluded if they had any other type of hip fracture, a fracture determined to be pathological due to an underlying malignancy, or missing information. The presence of both minor and major complications following surgery within 30 days was assessed as the primary outcome. Covariates assessed included demographics and comorbidities such as age, sex, race, BMI, smoking status, ASA status, congestive heart failure (CHF), hypertension, diabetes, dyspnea, functional status, chronic obstructive pulmonary disorder, anesthesia used in the surgery, emergency operation, and days from admission to surgery. Unadjusted and adjusted odds ratio (OR) and corresponding 95% confidence intervals were obtained via logistic regression analyses. Results. We analyzed data from 4,074 patients. The frequency of complications was 17.7%, of which 40% were minor and 435 (60%) were major. Death within 28 days after the operation was the most frequent complication (185 cases, 42% of the major complications). Pneumonia and urinary tract infection (UTI) made up most of all the minor complications reported (47% and 44%, respectively). Independent associations identified as having a higher risk of complications in the adjusted models included age >65 years (OR=1.79 (95% CI: 1.33-2.42; p < 0.001), having surgery >2 days from admission (OR=1.45,95% CI: 1.09-1.92; p < 0.010), ASA Class IV (OR= 2.71, 95% CI: 1.99-3.68); p < 0.001 compared to ASA status of 1 and presence of CHF (OR= 1.54, 95% CI: (1.03-2.30); p < 0.05, and partially/totally functionally dependent (OR = 1.45, 95% CI: 1.20-1.76); p < 0.001 compared to independent functional status. Conclusions-Implications. While some of the risk factors for complications for intertrochanteric fractures were not preventable such as age, potentially preventable risk factors such as a delay in surgery should be minimized. Aiming for a goal from the time of admission to surgery within 48 hours can potentially reduce mortality and complications for intertrochanteric hip fractures. Future work is encouraged to look at hospital processes to reduce potentially avoidable delays in care.
Keywords
orthopedics, hip fracture, trauma, intertrochanteric, risk factors
Presentation Type
Poster Presentation
The Characterization of Risk Factors Associated with Complications following Intertrochanteric Hip Fractures Surgery
Introduction and Objective. Intertrochanteric hip fractures are one of the more common hip fractures experienced, and they are associated with a higher mortality than femoral neck fractures. We aimed to assess which patient characteristics were associated with a higher incidence of postoperative complications and mortality in adults undergoing intertrochanteric hip fracture repair. Methods. A retrospective cohort study of adults who underwent intertrochanteric hip fractures was identified using the 2017-2020 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients were excluded if they had any other type of hip fracture, a fracture determined to be pathological due to an underlying malignancy, or missing information. The presence of both minor and major complications following surgery within 30 days was assessed as the primary outcome. Covariates assessed included demographics and comorbidities such as age, sex, race, BMI, smoking status, ASA status, congestive heart failure (CHF), hypertension, diabetes, dyspnea, functional status, chronic obstructive pulmonary disorder, anesthesia used in the surgery, emergency operation, and days from admission to surgery. Unadjusted and adjusted odds ratio (OR) and corresponding 95% confidence intervals were obtained via logistic regression analyses. Results. We analyzed data from 4,074 patients. The frequency of complications was 17.7%, of which 40% were minor and 435 (60%) were major. Death within 28 days after the operation was the most frequent complication (185 cases, 42% of the major complications). Pneumonia and urinary tract infection (UTI) made up most of all the minor complications reported (47% and 44%, respectively). Independent associations identified as having a higher risk of complications in the adjusted models included age >65 years (OR=1.79 (95% CI: 1.33-2.42; p < 0.001), having surgery >2 days from admission (OR=1.45,95% CI: 1.09-1.92; p < 0.010), ASA Class IV (OR= 2.71, 95% CI: 1.99-3.68); p < 0.001 compared to ASA status of 1 and presence of CHF (OR= 1.54, 95% CI: (1.03-2.30); p < 0.05, and partially/totally functionally dependent (OR = 1.45, 95% CI: 1.20-1.76); p < 0.001 compared to independent functional status. Conclusions-Implications. While some of the risk factors for complications for intertrochanteric fractures were not preventable such as age, potentially preventable risk factors such as a delay in surgery should be minimized. Aiming for a goal from the time of admission to surgery within 48 hours can potentially reduce mortality and complications for intertrochanteric hip fractures. Future work is encouraged to look at hospital processes to reduce potentially avoidable delays in care.