September 30, 2008
View Full PaperEarly mortality after surgical fixation of hip fractures in the elderly
Key Result
Patient case-mix variables (e.g., age, ASA score) were strongly associated with post-operative mortality, whereas management variables provided no significant improvement to the model.
Study Design
Type
Observational (n=18,817)
Multicenter
Yes
Structured PICO
Do management variables affect post-operative mortality more than case-mix variables in elderly patients undergoing surgery for hip fracture?
P
Population
18,817 elderly patients undergoing surgical fixation of hip fractures from the Scottish Hip Fracture Audit database.
E
Exposure
Management variables (time from fracture to surgery; time from admission to surgery; grade of surgical and anaesthetic staff undertaking the procedure and anaesthetic technique)
C
Comparator
Case-mix variables (age; gender; fracture type; pre-fracture residence; pre-fracture mobility and ASA scores)
O
Outcome
Post-operative mortalityhard clinical
Patient case-mix variables, rather than modifiable management variables, are the primary determinants of early post-operative mortality following hip fracture surgery in the elderly.
Abstract
We investigated the relationship between a number of patient and management variables and mortality after surgery for fracture of the hip. Data relating to 18,817 patients were obtained from the Scottish Hip Fracture Audit database. We divided variables into two categories, depending on whether they were case-mix (age; gender; fracture type; pre-fracture residence; pre-fracture mobility and ASA scores) or management variables (time from fracture to surgery; time from admission to surgery; grade of surgical and anaesthetic staff undertaking the procedure and anaesthetic technique). Multivariate logistic regression analysis showed that all case-mix variables were strongly associated with post-operative mortality, even when controlling for the effects of the remaining variables. Inclusion of the management variables into the case-mix base regression model provided no significant improvement to the model. Patient case-mix variables have the most significant effect on post-operative mortality and unfortunately such variables cannot be modified by pre-operative medical interventions.