Preoperative heart failure in hip fracture patients was associated with a 3-fold higher risk of postoperative heart failure (HR 3.0) and increased postoperative mortality.
Cohort (n=1,116)
No
Does preoperative heart failure worsen postoperative outcomes and mortality in patients undergoing hip fracture repair?
Preoperative heart failure is a common and serious condition in hip fracture patients that significantly increases the risk of postoperative morbidity and mortality.
Hazard Ratio: 3
BACKGROUND: Hip fracture and heart failure are becoming more prevalent conditions in hospitalized patients. Despite differences in postoperative outcomes from other intermediate risk procedures, guidelines classify hip fracture repair as an intermediate risk operation. OBJECTIVE: This population-based study sought to examine the prevalence and incidence of heart failure in hip fracture patients. DESIGN, SETTING, AND PATIENTS: We conducted a population-based historical cohort study of 1116 Olmsted County, MN residents undergoing 1212 hip surgeries from 1988 through 2002. Data were obtained through medical record review. Heart failure was defined by Framingham criteria. RESULTS: The prevalence of preoperative heart failure in our study population was 27% (327 of 1212 cases). Those with preoperative heart failure demonstrated longer lengths of stay, were more often discharged to a skilled facility, and had higher inpatient mortality rates. Rates of postoperative heart failure were 6.7% at seven days and 21.3% at one year. Postoperative heart failure was more common among those with preoperative heart failure (HR 3.0), and those with preoperative heart failure demonstrated higher postoperative mortality rates. Men had a higher risk of postoperative mortality compared to women. Overall survival was lowest among those with both preoperative and postoperative heart failure. CONCLUSIONS: Heart failure represents a common and serious perioperative condition in hip fracture patients. Hip fracture patients with and without heart failure carry higher postoperative risk than guidelines may suggest. Future work must focus on the perioperative management of hip fracture patients with and without heart failure to mitigate postoperative morbidity.
Cullen et al. (Mon,) conducted a cohort in Hip fracture (n=1,116). Preoperative heart failure vs. No preoperative heart failure was evaluated on Postoperative heart failure (HR 3.0). Preoperative heart failure in hip fracture patients was associated with a 3-fold higher risk of postoperative heart failure (HR 3.0) and increased postoperative mortality.