Bhanu P Gupta1, Rachel C Steckelberg2, Rachel E Gullerud3, Paul M Huddleston4, Lisa L Kirkland5, R Scott Wright6, Jeanne M Huddleston5,7. 1. Division of Cardiovascular Diseases, University of Missouri, Kansas City, Missouri. 2. Department of Anesthesiology and Perioperative Medicine, Ronald Reagan Medical Center, University of California at Los Angeles, Los Angeles, California. 3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. 4. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. 5. Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota. 6. Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 7. Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Abstract
OBJECTIVES: To determine the incidence and 1-year outcomes of an elderly population with perioperative atrial arrhythmia (PAA) within 7 days of hip fracture surgery. DESIGN: Retrospective cohort study. SETTING: The Rochester Epidemiology Project (REP). PARTICIPANTS: Elderly adults consecutive undergoing hip fracture repair from 1988 to 2002 in Olmsted County, Minnesota (N = 1,088, mean age 84.0 ± 7.4, 80.2% female). MEASUREMENTS: Baseline clinical variables were analyzed in relation to survival using Cox proportional hazards methods for comparison. RESULTS: Sixty-one participants (5.6%) developed PAA within the first 7 days. During 1 year of follow-up, 239 (22%) participants died. PAA was associated with greater mortality (45% vs 21%; hazard ratio (HR) = 2.8, 95% confidence interval (CI) = 1.9-4.2). Other mortality risk factors were male sex (HR = 2.0, 95% CI = 1.5-2.6), congestive heart failure (HR = 2.1, 95% CI = 1.7-2.8), chronic renal insufficiency (HR = 2.0, 95% CI = 1.5-2.8), dementia (HR = 2.9, 95% CI = 2.2-3.7), and American Society of Anesthesiologists risk Class III, IV, or V (HR = 3.3, 95% CI = 1.9-5.9). CONCLUSION: Elderly adults undergoing hip fracture surgery who develop PAA within 7 days have significantly higher 1-year mortality than those who do not. Further studies are indicated to determine whether prevention of PAA will reduce mortality in this population.
OBJECTIVES: To determine the incidence and 1-year outcomes of an elderly population with perioperative atrial arrhythmia (PAA) within 7 days of hip fracture surgery. DESIGN: Retrospective cohort study. SETTING: The Rochester Epidemiology Project (REP). PARTICIPANTS: Elderly adults consecutive undergoing hip fracture repair from 1988 to 2002 in Olmsted County, Minnesota (N = 1,088, mean age 84.0 ± 7.4, 80.2% female). MEASUREMENTS: Baseline clinical variables were analyzed in relation to survival using Cox proportional hazards methods for comparison. RESULTS: Sixty-one participants (5.6%) developed PAA within the first 7 days. During 1 year of follow-up, 239 (22%) participants died. PAA was associated with greater mortality (45% vs 21%; hazard ratio (HR) = 2.8, 95% confidence interval (CI) = 1.9-4.2). Other mortality risk factors were male sex (HR = 2.0, 95% CI = 1.5-2.6), congestive heart failure (HR = 2.1, 95% CI = 1.7-2.8), chronic renal insufficiency (HR = 2.0, 95% CI = 1.5-2.8), dementia (HR = 2.9, 95% CI = 2.2-3.7), and American Society of Anesthesiologists risk Class III, IV, or V (HR = 3.3, 95% CI = 1.9-5.9). CONCLUSION: Elderly adults undergoing hip fracture surgery who develop PAA within 7 days have significantly higher 1-year mortality than those who do not. Further studies are indicated to determine whether prevention of PAA will reduce mortality in this population.
Authors: Karen P Alexander; L Kristin Newby; Paul W Armstrong; Christopher P Cannon; W Brian Gibler; Michael W Rich; Frans Van de Werf; Harvey D White; W Douglas Weaver; Mary D Naylor; Joel M Gore; Harlan M Krumholz; E Magnus Ohman Journal: Circulation Date: 2007-05-15 Impact factor: 29.690