Key result
Recent MI is linked to ~18.3-fold higher odds of severe complications after hip fracture surgery.
Why the study?
Postoperative complications significantly impact recovery and overall health in frail and older patients undergoing hip fracture surgery, motivating the identification of predictors associated with severe Clavien-Dindo grade ≥ 3 complications.
Cohort (n=417)
No
Odds Ratio: 18.28 (95% CI 2.01–141.32)
p-value: p=0.013
In older patients undergoing hip fracture surgery, male sex, recent myocardial infarction within 6 months, preoperative ECG abnormalities, preoperative dementia, surgical delay >24 hours, and postoperative acute kidney injury strongly predict severe postoperative complications (Clavien-Dindo grade ≥ III) with an AUC of 0.825.
May inform perioperative risk stratification in elderly hip fracture patients; hypothesis-generating until prospectively validated.
Background Postoperative complications significantly impact recovery and overall health in frail and older patients undergoing hip fracture surgery. This study aims to determine the predictors associated with severe complications, as classified by the Clavien-Dindo system (grade ≥ 3). Methods A retrospective cohort study was conducted on patients aged ≥ 65 years who underwent hip fracture surgery from January 2019 to December 2024. We assessed complication severity using the Clavien-Dindo classification, categorizing cases as minor (grade < III) or severe (grade ≥ III). Logistic regression analyses were performed to identify factors independently associated with severe complications, and a corresponding risk estimation model was developed. Results Among 417 analyzed patients, 22 (5.3%) developed Clavien-Dindo ≥ III complications. Multivariable logistic regression revealed that male sex, Preoperative ECG abnormality, Myocardial infarction within the previous 6 months, preoperative dementia, surgery delayed more than 24 h, and postoperative acute kidney injury (AKI) were independently associated with severe complications ( P < 0.05). Based on these variables, the resulting calculator demonstrated good discriminative performance, with an area under the ROC curve (AUC) of 0.825. Conclusion Several perioperative factors were associated with severe postoperative complications following hip fracture surgery. The derived model demonstrated good discrimination in this single-center cohort; however, external validation is required before its broader clinical application. Clinical trial number Not applicable.
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Sutthibenjakul et al. (2026) conducted a cohort in Hip fracture undergoing surgical repair in older patients (n=417). Perioperative clinical risk factors (male sex, preoperative ECG abnormality, MI within 6 months, dementia, surgical delay >24 h, postoperative AKI) vs. Absence of high-risk perioperative predictors was evaluated on Severe postoperative complications (Clavien-Dindo classification grade >= III) (OR 18.28 (for myocardial infarction within 6 months), 95% CI 2.01-141.32, p=0.013). Perioperative risk factors including recent MI (OR 18.28), dementia (OR 12.58), and AKI (OR 11.64) predicted severe complications (5.3% incidence) after hip fracture surgery (model AUC 0.825).
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