Key result
Dementia was associated with a significantly increased risk of 30-day postoperative mortality after first-time hip fracture compared to no dementia (HR 1.50; 95% CI 1.31-1.72).
Why the study?
Patients with dementia experience increased 30-day mortality after hip fracture, prompting investigation into whether clinical management factors explain this excess risk.
Do preoperative clinical management factors explain the increased 30-day mortality in elderly patients with dementia following hip fracture surgery?
Cohort (n=12,309)
Do preoperative clinical management factors explain the increased 30-day mortality in elderly patients with dementia following hip fracture surgery?
Hazard Ratio: 1.5 (95% CI 1.31–1.72)
The increased 30-day mortality in elderly patients with dementia after hip fracture surgery is not explained by preoperative clinical management factors, suggesting postoperative care and rehabilitation may play a role.
Postoperative care may drive excess mortality in dementia after hip fracture; hypothesis-generating for targeted rehabilitation trials.
OBJECTIVES: Patients with dementia have an increased 30-day mortality after hip fracture. We investigated clinical management including time to surgery, out-of-hours admission and surgery, surgery on weekends, surgery volume per ward, and anesthesia technique for this excess mortality risk. METHOD: This register- and population-based study comprised 12,309 older adults (age 70+) admitted to hospital for a first-time hip fracture in 2013-2014, of whom 11,318 underwent hip fracture surgery. Cox proportional hazards regression models were applied for the analysis. RESULTS: The overall postoperative 30-day mortality was 11.4%. Patients with dementia had a 1.5 times increased mortality risk than those without (HR = 1.50 [95% CI 1.31-1.72]). We observed no time-to-surgery difference by patient dementia status; additionally, the excess mortality risk in patients with dementia could not be explained by the clinical management factors we examined. CONCLUSIONS: Increased mortality in patients with dementia could not be explained by the measured preoperative clinical management. Suboptimal handling of postoperative complication and rehabilitation are to be investigated for their role in the witnessed increased mortality for patients with dementia.
No takes yet. Share an insight, caveat, or question.
Petersen et al. (2020) conducted a cohort in First-time hip fracture (n=12,309). Dementia vs. No dementia was evaluated on Postoperative 30-day mortality (HR 1.50, 95% CI 1.31-1.72). Dementia was associated with a significantly increased risk of 30-day postoperative mortality after first-time hip fracture compared to no dementia (HR 1.50; 95% CI 1.31-1.72).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: