Key result
Perioperative adverse cardiac events predict ~201% higher post-discharge mortality after hip fracture, especially without prior CVD.
Why the study?
Perioperative adverse cardiac events (PACEs) are linked to perioperative mortality in elderly hip fracture patients, but their relationship with post-discharge mortality and potential differences between patients with and without cardiovascular disease remained to be explored.
Does the occurrence of perioperative adverse cardiac events predict post-discharge mortality in elderly patients undergoing fragility hip fracture surgery?
Cohort (n=446)
No
Does the occurrence of perioperative adverse cardiac events predict post-discharge mortality in elderly patients undergoing fragility hip fracture surgery?
Hazard Ratio: 3.01 (95% CI 1.69–5.35)
p-value: p=<0.001
Perioperative adverse cardiac events strongly predict post-discharge mortality in elderly patients undergoing fragility hip fracture surgery, particularly in those without prior cardiovascular disease.
Supports risk stratification by perioperative cardiac events after fragility hip fracture; leaves open whether targeted interventions improve survival.
Background Perioperative adverse cardiac events (PACEs) in elderly patients with hip fractures are associated with perioperative mortality. We investigated the relationship of PACE with post-discharge mortality and further explored whether it differs between patients with and without cardiovascular disease (CVD). Methods We retrospectively analyzed data from patients aged ≥ 65 years who underwent fragility hip fracture surgery from September 2016 to December 2021. PACE was defined as a composite of congestive heart failure, cardiogenic shock, myocardial injury after non-cardiac surgery, arrhythmic event, ischemic stroke, or acute pulmonary thromboembolism during hospitalization or within the 30-day postoperative period. Patients with 30-day mortality were excluded. The primary endpoint was all-cause mortality after hospital discharge. Results Of the 446 patients (133 patients in the CVD group and 313 patients in the non-CVD group), 14.8% experienced PACE, and overall mortality during a median of 15.9 months (interquartile range: 6.6-27.0 months) was 20.9% [CVD (26.3%) vs. non-CVD (18.5%), P = 0.064]. Patients with PACE demonstrated a significantly worse survival rate than those without PACE in both groups (all log-rank P < 0.05). After adjustment for confounders, PACE was an independent predictor of mortality in the overall population [hazard ratio (HR) = 3.01, 95% CI: 1.69-5.35, P < 0.001]. Its prognostic impact was significant in patients without CVD (HR = 2.69, 95% CI: 1.35-5.38, P = 0.005) but not in those with CVD (HR = 1.20, 95% CI: 0.41-3.50, P = 0.735). Conclusions PACE was associated with increased post-discharge mortality after fragility hip fracture, especially in elderly patients without CVD.
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Kim et al. (2024) conducted a cohort in Fragility hip fracture (n=446). Perioperative adverse cardiac events (PACE) vs. No perioperative adverse cardiac events was evaluated on All-cause mortality after hospital discharge (HR 3.01, 95% CI 1.69-5.35, p=<0.001). Perioperative adverse cardiac events independently predicted post-discharge mortality after fragility hip fracture (HR 3.01), particularly in patients without prior cardiovascular disease.
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