Research Articles

Influence of Risk Factors and Comorbidities on Postoperative Complications and Outcomes after Hip Fracture Surgery in the Elderly


Background: Older adults who sustain hip fractures usually have multiple comorbidities that may impact their treatment and outcome. This study was conducted with the aim to analyze the risk factors that contribute to falls in elderly individuals and analyze the effect of comorbidities on the outcome and the treatment in elderly patients with hip fractures.

Methods: This cohort study was conducted on patients with hip fractures. We prospectively analyzed 140 individuals with geriatric hip fractures who had undergone surgery. The Charlson Comorbidity Index (CCI) and American Society of Anesthesiology (ASA) score of each geriatric hip fracture patient were calculated based on data obtained from medical records. Clinical assessment was assessed using a modified Harris Hip Score (HHS) during each visit.

Results: The mean age of patients was 72.21 ± 12.2 years. Their mean CCI and ASA was 1.02 ± 0.3 and 2.0 ± 0.53, respectively, and both were significantly associated with time-to-surgery (P < 0.001) and surgical treatment (P < 0.001). The length of hospital stay, duration of postoperative intensive care, and hospital expenses were associated with both CCI (P = 0.037) and ASA (P = 0.002). The greater the CCI and ASA scores were, the higher the chances of developing postoperative complications were (X2 = 15.724; P = 0.001). Delirium was the most common postoperative complication (15.7%), and pulmonary infection (11.4%) was the most fatal complication.

Conclusion: Patients with high CCI and ASA grading, and revision surgery were at high risk of postoperative complications, morbidity, and mortality. Orthogeriatric care offers the best chance for a successful outcome through efficient medical co- management of these patients.

1. Swiontkowski MF, Winquist RA, Hansen ST. Fractures of the femoral neck in patients between the ages of twelve and forty- nine years. J Bone Joint Surg Am. 1984;66(6):837-46. doi: 10.2106/00004623-198466060-00003. [PubMed: 6736085].
2. Gallagher JC, Melton LJ, Riggs BL, Bergstrath E. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res. 1980;(150): 163-71. [PubMed: 7428215].
3. Hedlund R, Lindgren U, Ahlbom A. Age- and sex-specific incidence of femoral neck and trochanteric fractures. An analysis based on 20,538 fractures in Stockholm County, Sweden, 1972-1981. Clin Orthop Relat Res. 1987;(222):132-9. [PubMed: 3621713].
4. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: Prospective observational cohort study. BMJ. 2005;331(7529):1374. doi: 10.1136/bmj.38643.663843.55. [PubMed: 16299013]. [PMCID: PMC1309645].
5. Chong CP, Savige JA, Lim WK. Medical problems in hip fracture patients. Arch Orthop Trauma Surg. 2010;130(11):1355-61. doi: 10.1007/s00402-009-1038-y. [PubMed: 20049603].
6. Monte-Secades R, Pena-Zemsch M, Rabunal-Rey R, Bal-Alvaredo M, Pazos-Ferro A, Mateos-Colino A. Risk factors for the development of medical complications in patients with hip fracture. Rev Calid Asist. 2011;26(2):76-82. [In Spanish]. doi: 10.1016/j.cali.2010.09.003. [PubMed: 21339079].
7. Menzies IB, Mendelson DA, Kates SL, Friedman SM. The impact of comorbidity on perioperative outcomes of hip fractures in a geriatric fracture model. Geriatr Orthop Surg Rehabil. 2012;3(3):129-34. doi: 10.1177/2151458512463392. [PubMed: 23569706]. [PubMed Central: PMC3598442].
8. Handoll HH, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev. 2002;(4):CD000305. doi: 10.1002/14651858.CD000305. [PubMed: 12519540].
9. Kastanis G, Topalidou A, Alpantaki K, Rosiadis M, Balalis K. Is the ASA Score in geriatric hip fractures a predictive factor for complications and readmission? Scientifica (Cairo). 2016;2016:7096245. doi: 10.1155/2016/7096245. [PubMed: 27293978]. [PubMed Central: PMC4880678].
10. Je S, Kim H, Ryu S, Cho S, Oh S, Kang T, Choi S. The consequence of delayed diagnosis of an occult hip fracture. J Trauma Inj. 2015;28(3):91-7. doi: 10.20408/jti.2015.28.3.91.
11. Vidan MT, Sanchez E, Gracia Y, Maranon E, Vaquero J, Serra JA. Causes and effects of surgical delay in patients with hip fracture: A cohort study. Ann Intern Med. 2011;155(4):226-33. doi: 10.7326/0003-4819-155-4-201108160-00006. [PubMed: 21844548].
12. Smeets SJ, Poeze M, Verbruggen JP. Preoperative cardiac evaluation of geriatric patients with hip fracture. Injury. 2012;43(12):2146-51. doi: 10.1016/j.injury.2012.08.007. [PubMed: 22995981].
13. De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, et al. Body mass index as a predictor of fracture risk: A meta- analysis. Osteoporos Int. 2005;16(11):1330-8. doi: 10.1007/s00198- 005-1863-y. [PubMed: 15928804].
14. Shafiei SH, Ghaderzadeh S, Rastegar M, Siavashi B, Golbakhsh M, Mortazavi SJ. Mortality rate and quality of life in patients with intertrochanteric fractures treated with dynamic hip screw. J Orthop Spine Trauma. 2022;8(2):52-6. doi: 10.18502/jost.v8i2.9311.
15. Zandi R, Karimi A, Sadighi M, Minator Sajjadi M, Okhovatpour MA, Ebrahimpour A, et al. Primary long distal fitting bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients. J Orthop Spine Trauma. 2020;4(3):42-7. doi: 10.18502/jost.v4i3.3070.
16. Eschbach D, Bliemel C, Oberkircher L, Aigner R, Hack J, Bockmann B, et al. One-Year Outcome of geriatric hip-fracture patients following prolonged ICU treatment. Biomed Res Int. 2016;2016:8431213. doi: 10.1155/2016/8431213. [PubMed: 26881228]. [PubMed Central: PMC4737470].
17. Mousapour A, Mardanpour K, Hojabrian A, Saeb M, Khabiri SS, Safari-Faramani R, et al. A comparison of bipolar hemiarthroplasty versus dynamic hip screw fixation of basicervical femoral neck fractures. J Orthop Spine Trauma. 2020;5(1):25-8. doi: 10.18502/jost.v5i1.3321.
18. Saeb M, Mousapour A, Shafiee A, Khabiri SS, Safari-Faramani R, Gholami A, et al. Tranexamic acid effectiveness on the amount of bleeding during surgery and surgeon's satisfaction in intertrochanteric fracture fixation: A randomized clinical trial. J Orthop Spine Trauma. 2020;5(1):17-20. doi: 10.18502/jost.v5i1.3319.
19. Smeets SJM, van Wunnik BPW, Poeze M, Slooter GD, Verbruggen JPAM. Cardiac overscreening hip fracture patients. Arch Orthop Trauma Surg. 2020;140(1):33-41. doi: 10.1007/s00402-019-03270-z. [PubMed: 31471640]. [PubMed Central: PMC6942037].
20. Liu Z, Han N, Xu H, Fu Z, Zhang D, Wang T, et al. Incidence of venous thromboembolism and hemorrhage related safety studies of preoperative anticoagulation therapy in hip fracture patients undergoing surgical treatment: A case- control study. BMC Musculoskelet Disord . 2016;17:76. doi: 10.1186/s12891-016-0917-y. [PubMed: 26873584]. [PubMed Central: PMC4752756].
21. Hrubina M, Skotak M, Behounek J. Complications of dynamic hip screw treatment for proximal femoral fractures. Acta Chir Orthop Traumatol Cech. 2010;77(5):395-401. [In Czech]. [PubMed: 21040651].
22. Siddiqui Y, Khan AQ, Asif N, Sherwani M. Modes of failure of proximal femoral nail (PFN) in unstable trochanteric fractures. MOJ Orthop Rheumatol. 2019;11(1):7-16. doi: 10.15406/mojor.2019.11.00460.
IssueVol 8, No 4 (2022) QRcode
SectionResearch Articles
Hip Risk Factors Comorbidity

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Hussain KSA, Kund Reddy AS, Raju M, Patnala C. Influence of Risk Factors and Comorbidities on Postoperative Complications and Outcomes after Hip Fracture Surgery in the Elderly. J Orthop Spine Trauma. 2022;8(4):118-124.