By: Robert W. Griffith, MD
A broken hip is a complete or partial break in the proximal end of the femur (also called thighbone), near the hip joint..About 300,000 Americans are hospitalized for a broken hip every year.
Falls leading to a broken hip are fairly common in older folk. The outcome after surgery seems to depend a lot on the risk of postoperative complications, which themselves are influenced by the general health of the patient before their injury.
Broken Hip & Elderly Mortality: Mortality increases in the elderly within a year of suffering from a broken hip.
|A broken hip, or hip fracture, is a common injury in the elderly. In the USA, hip fractures are the most common broken bone that requires hospitalization. More than 350,000 people are hospitalized for a broken hip every year and about 90% of hip fractures occur in people over 60.|
Most people who fall and break their hip are well over 60, and are therefore likely to have accumulated one or more chronic conditions, such as overweight, high blood pressure, or diabetes. In fact, quite a few of them die within a year of their fracture - as many as 20%, a number that increases with age. Such deaths are usually due to post-surgical complications, which are, of course, influenced by the general health of the patient before operation.
Orthopedic surgeons in Nottingham, England, have studied the role of postoperative problems in people dying within 30 days or one year of their surgery for a fractured hip. Their findings are published in British Medical Journal, and summarized here.
The surgeons examined the records of 2,448 consecutive patients over 60 who were admitted with a broken hip over a 4-year period. The data collected included the type of fracture, preoperative medical conditions, the surgery performed, and postoperative complications.
The mortality rates at 30 days and at 1 year after surgery were calculated, and examined to see what factors, if any, predisposed to a high mortality rate.
The average age of the patients was 82 (the range ran from 60 to 103 years). Overall, mortality from any cause was high - nearly 10% after 30 days, and 33% at one year. It was much higher in men than women at the 30-day mark - 15% vs. 8%.
Postoperative complications were seen in 14% of the patients overall, but in those who were healthy before their broken hip (i.e. had no preoperative medical conditions) it was only 9%.
The biggest factor affecting mortality was the development of postoperative congestive heart failure; those in whom this happened had 65% mortality after 30 days, and 92% were dead after one year.
A postoperative chest infection (pneumonia, bronchitis) was also a detrimental factor; mortality at 30 days in such patients was 43%.
Preoperative medical conditions were reported in 59% of the patients. They included cardiovascular disease, stroke, respiratory disease, kidney disease, diabetes, rheumatoid arthritis, Parkinson's, and cancer; 35% of patients had one, 17% had two, and 7% had three or more preoperative medical conditions.
Mortality at 30 days was increased in those with three or more preoperative conditions, particularly respiratory and kidney disease. And at one year, just about all the preoperative conditions played a role in limiting survival.
In particular, respiratory disease, taking oral steroid drugs, and greater age were important factors for developing a chest infection post-operatively. Similarly, preoperative cardiovascular disease and being male were risk factors for postoperative heart failure.
Obviously, those patients who were sick with other conditions before their broken hip occurred were at greater risk for postoperative complications (chiefly heart failure and chest infection), and hence at a greater risk of dying, both soon (30 days) and later (one year). The challenge for physicians treating these injuries is to recognize predisposing factors for a bad outcome, and manage them accordingly. Specialist medical assessment both before and after surgery to correct the fracture is called for. This may require intensive monitoring activity, both before and immediately after surgery.
Of course, once again we call for old folk to try to stay as healthy as possible right into their 80s and 90s. This means they should have adapted a healthy lifestyle in their 60s (or earlier) and continued to exercise and eat healthily ever after. A lot to ask, but the benefits are obvious!