Key result
Prior stroke combined with hip fracture linked to a ~17-fold increase in 30-day mortality.
Why the study?
It remains uncertain how a history of stroke impacts the prognosis for patients undergoing hip fracture surgery.
Does a history of stroke increase postoperative mortality in patients aged 65 years or older undergoing hip fracture surgery?
Cohort (n=587,722)
Yes
Does a history of stroke increase postoperative mortality in patients aged 65 years or older undergoing hip fracture surgery?
Hazard Ratio: 17.3 (95% CI 16.1–18.6)
Absolute Event Rate: 148.4% vs 8.4%
A history of stroke significantly increases the risk of 30-day mortality following hip fracture surgery, highlighting the need for rigorous attention to early postoperative complications in this vulnerable population.
Prior stroke associated with excess 30-day mortality after hip fracture surgery; hypothesis-generating for risk stratification in future studies.
Purpose: It remains uncertain how a history of stroke impacts the prognosis for patients with hip fracture. This study aimed to evaluate mortality following hip fracture surgery by comparing patients with and without a history of stroke. Patients and Methods: All patients aged 65 years or above in Denmark receiving hip fracture surgery between 2010 and 2018. For every patient, 10 individuals from the general population without hip fracture were sampled. Comparators had a similar stroke history, age, and sex on the date of hip fracture surgery (index date). We established four cohorts: hip fracture patients with/without stroke and non-hip fracture patients with/without stroke. Outcomes were all-cause mortality at 0-30 days, 31-365 days and 1 to 5 years. Direct standardized mortality rates (MR) with 95% confidence intervals (CI) were computed. We calculated the interaction contrast to estimate excess absolute mortality among patients with both hip fracture and stroke. Through a Cox proportional hazards model, we estimated the hazard ratio (HR) and the attributable proportion as a measure of excess relative mortality attributable to interaction. Results: Of the hip fracture patients, 8433 had a stroke history and 44,997 did not. Of the non-hip fracture patients, 84,330 had a stroke history and 449,962 did not. Corresponding 30-day MRs/100 person years were 148.4 (95% CI: 138.8-158.7), 124.3 (95% CI: 120.7-128.1), 14.3 (95% CI: 13.4-15.2) and 8.4 (95% CI: 8.1-8.7). The interaction contrast was 18.2 (95% CI: 7.5-28.8), and the attributable proportion was 9.0% (95% CI: 2.9-15.1). No interaction was present beyond 30 days. Conclusion: We observed excess short-term mortality in patients with stroke and hip fracture, but the effect disappeared at later follow-up periods. Clinicians are encouraged to pay rigorous attention to early complications among hip fracture patients with stroke, as this may serve as a way to reduce mortality.
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Hjelholt et al. (2022) conducted a cohort in Hip fracture and stroke (n=587,722). History of stroke and hip fracture vs. No history of stroke and no hip fracture was evaluated on All-cause mortality at 0-30 days (HR 17.3, 95% CI 16.1-18.6). The combination of previous stroke and hip fracture resulted in a synergistic increase in 30-day mortality, with an interaction contrast of 18.2 excess deaths per 100 person-years.
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