Paa Kwesi Baidoo1,2, James B Odei3, Velarie Ansu4, Michael Segbefia5, Henry Holdbrook-Smith5. 1. Directorate of Orthopedics and Trauma, Komfo Anokye Teaching Hospital, Kumasi, Ghana. pakvandal@gmail.com. 2. Orthopedics Unit, Department of Surgery University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana. pakvandal@gmail.com. 3. Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA. 4. School of Public Health, Indiana University Bloomington, Bloomington, IN, USA. 5. Orthopedics Unit, Department of Surgery University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana.
Abstract
To determine risk factors influencing mortality in patients with proximal femur fractures in a Ghanaian hospital over a 4-year period. METHODS: Incidence of mortality was assessed among 76 participants with proximal femur fractures from January to December 2014 and followed up for 4 years. Outcomes of interest were mortality at 1 month, 6 months, 1 year, and 4 years. Hazard ratios (HRs) were calculated using Cox proportional hazards regression, adjusting for mortality risk factors. RESULTS: Among the 76 participants (mean age 75.8 years [SD = 12.02], 36 (47.4%) males), there were 21 death cases. The mean time of injury to surgery was 16.4 (SD = 16.2) days. Hip fractures comprised of 38 (50%) intertrochanteric, 35 (46.05%) transcervical, and 3 (3.95%) basicervical. Mortality at 1 month, 6 months, 1 year, and 4 years were 6.6%, 13.2%, 19.7%, and 27.6%, respectively. Multiple regression analysis showed a yearly increase in age that was associated with a 1.03-fold increase in the risk of death (p = 0.17). Comparing males to females, there was a significant difference in mortality (HR = 5.24, p = 0.03). Participants with basicervical hip fracture versus those with transcervical hip fracture were at higher risk of dying (HR = 28.88, p = 0.01). Patients with abnormal/low creatinine as compared to those with normal creatinine were at higher risk of dying (HR = 5.64, p = 0.005). Also, participants with an American Society of Anesthesiologists (ASA) score of III or IV were 2.73 times more likely to experience death than those with an ASA score of I or II (95% CI: 0.93-8.89, p = 0.08). Additionally, a higher risk of death was associated with patients with chronic obstructive pulmonary disease (COPD) (HR = 53.45, p = 0.001) and osteoporosis (HR = 8.75, p = 0.006). CONCLUSION: Being male, having basicervical hip fracture, abnormal/low creatinine, and a history of COPD and osteoporosis were the main predictors of mortality in the study population. These findings could serve as a guide when managing patients with proximal femur fractures to improve the outcome.
To determine risk factors influencing mortality in patients with proximal femur fractures in a Ghanaian hospital over a 4-year period. METHODS: Incidence of mortality was assessed among 76 participants with proximal femur fractures from January to December 2014 and followed up for 4 years. Outcomes of interest were mortality at 1 month, 6 months, 1 year, and 4 years. Hazard ratios (HRs) were calculated using Cox proportional hazards regression, adjusting for mortality risk factors. RESULTS: Among the 76 participants (mean age 75.8 years [SD = 12.02], 36 (47.4%) males), there were 21 death cases. The mean time of injury to surgery was 16.4 (SD = 16.2) days. Hip fractures comprised of 38 (50%) intertrochanteric, 35 (46.05%) transcervical, and 3 (3.95%) basicervical. Mortality at 1 month, 6 months, 1 year, and 4 years were 6.6%, 13.2%, 19.7%, and 27.6%, respectively. Multiple regression analysis showed a yearly increase in age that was associated with a 1.03-fold increase in the risk of death (p = 0.17). Comparing males to females, there was a significant difference in mortality (HR = 5.24, p = 0.03). Participants with basicervical hip fracture versus those with transcervical hip fracture were at higher risk of dying (HR = 28.88, p = 0.01). Patients with abnormal/low creatinine as compared to those with normal creatinine were at higher risk of dying (HR = 5.64, p = 0.005). Also, participants with an American Society of Anesthesiologists (ASA) score of III or IV were 2.73 times more likely to experience death than those with an ASA score of I or II (95% CI: 0.93-8.89, p = 0.08). Additionally, a higher risk of death was associated with patients with chronic obstructive pulmonary disease (COPD) (HR = 53.45, p = 0.001) and osteoporosis (HR = 8.75, p = 0.006). CONCLUSION: Being male, having basicervical hip fracture, abnormal/low creatinine, and a history of COPD and osteoporosis were the main predictors of mortality in the study population. These findings could serve as a guide when managing patients with proximal femur fractures to improve the outcome.
Entities:
Keywords:
Ghana; Hip fracture; Mortality; Risk factors
Authors: Suneetha Ramani Moonesinghe; Michael G Mythen; Priya Das; Kathryn M Rowan; Michael P W Grocott Journal: Anesthesiology Date: 2013-10 Impact factor: 7.892