Impact of prior fragility fracture on patient’s mortality, outcomes, and complications after hip fracture surgery

BACKGROUND: Osteoporosis, a common metabolic bone condition primarily affecting geriatrics globally, weakens bones and raises fracture risk. Prior osteoporotic fractures heighten susceptibility to further fractures, notably hip fractures, impacting outcomes post-surgical management. Analyzing this link is vital for optimizing interventions for at-risk individuals. This study investigates these associations and suggests interventions for high-risk patients. METHODS: This study is a retrospective case-control analysis of 1234 patients who underwent hip fracture surgery. Hospital records from two teaching university hospitals and two major governmental hospitals in Jordan over a three-year period were reviewed. Data encompassed patient demographics, comorbidities, perioperative variables, and postoperative outcomes and complications. RESULTS: Of the 1234 patients, 124 (10%) had prior fragility fractures (PFF): 85 contralateral hip (68.5%), 25 distal radius (20.2%), and 18 proximal humerus fractures (14.5%). Patients with prior contralateral hip fractures had higher rates of hypertension (55.5% vs. 41.1%, p = 0.03) and dementia (3.5% vs. 2.1%, p = 0.09), with trends in diabetes (38.8% vs. 31.3%, p = 0.17) and ICU admissions (7.0% vs. 4.3%, p = 0.33) that were not statistically significant. Blood transfusion rates were comparable (35.3% vs. 33.4%, p = 0.82). Subgroup analysis showed that patients with prior proximal humerus fractures had significantly higher postoperative strong analgesic use (60.5% vs. 43.2%, p = 0.007) and increased rates of dementia compared to other subgroups. However, these findings were specific to this subgroup and cannot be generalized to all PFF patients. The one-year all-cause mortality rate was 10.6% for patients with PFF and 6.2% for those without (p = 0.22). Although not statistically significant, this trend may hold clinical relevance in understanding the prognosis of this high-risk subgroup. CONCLUSION: patients with prior contralateral hip fractures exhibited higher chances of postoperative ICU admission and increased comorbidity rates. This highlights the necessity for tailored care for this subgroup. LEVEL OF EVIDENCE: Level III, Retrospective cohort study.