Between 2006 and 2016, the proportion of hip fracture repair patients with >3 comorbidities increased significantly from 33.9% to 43.4% (P<0.0001), alongside rising rates of acute renal failure.
Observational (n=507,274)
Yes
Between 2006 and 2016, patients undergoing hip fracture repair in the US presented with an increasing comorbidity burden, yet postoperative complications generally remained constant or declined, with the exception of acute renal failure.
Absolute Event Rate: 43.4% vs 33.9%
p-value: p=<0.0001
BACKGROUND: Hip fracture patients represent various perioperative challenges related to their significant comorbidity burden and the high incidence of morbidity and mortality. As population trend data remain rare, we aimed to investigate nationwide trends in the United States in patient demographics and outcomes in patients after hip fracture repair surgery. METHODS: After Institutional Review Board (IRB) approval (IRB#2012-050), data covering hip fracture repair surgeries were extracted from the Premier Healthcare Database (2006-2016). Patient demographics, comorbidities, and complications, as well as anesthesia and surgical details, were analyzed over time. Cochran-Armitage trend tests and simple linear regression assessed significance of (linear) trends. RESULTS: Among N = 507,274 hip fracture cases, we observed significant increases in the incidence in preexisting comorbid conditions, particularly the proportion of patients with >3 comorbid conditions (33.9% to 43.4%, respectively; P < .0001). The greatest increase for individual comorbidities was seen for sleep apnea, drug abuse, weight loss, and obesity. Regarding complications, increased rates over time were seen for acute renal failure (from 6.9 to 11.1 per 1000 inpatient days; P < .0001), while significant decreasing trends for mortality, pneumonia, hemorrhage/hematoma, and acute myocardial infarction were recorded. In addition, decreasing trends were observed for the use of neuraxial anesthesia either used as sole anesthetic or combined with general anesthesia (7.3% to 3.6% and 6.3% to 3.4%, respectively; P < .0001). Significantly more patients (31.9% vs 41.3%; P < .0001) were operated on in small rather than medium- and large-sized hospitals. CONCLUSIONS: From 2006 to 2016, the overall comorbidity burden increased among patients undergoing hip fracture repair surgery. Throughout this same time period, incidence of postoperative complications either remained constant or declined with the only significant increase observed in acute renal failure. Moreover, use of regional anesthesia decreased over time. This more comorbid patient population represents an increasing burden on the health care system; however, existing preventative measures appear to be effective in minimizing complication rates. Although, given the proposed benefits of regional anesthesia, decreased utilization may be of concern.
Bekeris et al. (Thu,) conducted a observational in Hip fracture (n=507,274). Time period (2016) vs. Time period (2006) was evaluated on Proportion of patients with >3 comorbid conditions (p=<0.0001). Between 2006 and 2016, the proportion of hip fracture repair patients with >3 comorbidities increased significantly from 33.9% to 43.4% (P<0.0001), alongside rising rates of acute renal failure.