Increased risk of hip fracture mortality associated with intraoperative hypotension in elderly hip fracture patients is related to under resuscitation |
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| Affiliation: | 1. Department of Orthopaedic and Plastic Surgery, Wright State University Boonshoft School of Medicine, United States;2. Wright State University Boonshoft School of Medicine, United States;3. Department of Kinesiology and Health, Wright State University, United States;4. Premier Health Department of Orthopedic Surgery, United States;1. Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, Rajasthan, India;2. Aarupadai Veedu Medical College and Hospital, Puducherry, India;3. Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA;1. Guy''s and St Thomas'' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK;2. Trauma and Orthopaedic Department, Maidstone and Tunbridge Wells NHS Trust, Tonbridge Road, Royal Tunbridge Wells, TN2 4QJ, UK;3. Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch, New Zealand;4. Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria;1. Departments of Orthopedics, Southport and Ormskirk NHS Trust, Southport, UK;2. Departments of Musculoskeletal Radiology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK;3. Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK;4. Departments of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK;5. Departments of Surgery, Altnagelvin Area Hospital, Glenshane Road, Londonderry, UK |
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| Abstract: | BackgroundAs the US and world population ages, hip fractures are increasingly more common. The mortality associated with these fractures remains high both in the immediate postoperative period and at one year. Perioperative resuscitation in this population is of key interest to prevent organ injury and mortality. Our objectives were to evaluate the effect of fluid resuscitation and hemodynamic status in the form of mean arterial pressure (MAP) on inpatient mortality of hip fracture patients.MethodsAn institutional database was queried to compare elderly hip fracture patients that sustained in-hospital mortality to a matched control cohort. Pre-, intra-, and post-operative intravenous fluid (IVF) administration and MAP were extracted from the electronic medical record. Time from hospital presentation to the OR was also recorded.Results1,114 total hip fractures were identified during the two-year study period, 16 of which suffered inpatient mortalities. The mortality cohort was then matched with a control of 394 hip fracture patients for the same period based on age, sex, and Charlson Comorbidity Index (CCI). Conditional logistical regression analysis found odds ratios (OR) indicating that longer time between presentation and surgery (OR per additional hour: 1.05; 95% CI: 1.01–1.08) and lower intraoperative minimum MAP (OR per 5 mmHg decrease: 0.77; 95% CI: 0.61–0.97) were associated with significantly increased odds of mortality. There was also a marginal relationship between greater intraoperative IVF administration and reduced odds of mortality (OR per 500 cc additional fluid: 0.61; 95% CI: 0.37–1.00).ConclusionExtended time from presentation to surgery and intraoperative hypotension were associated with increased likelihood of inpatient mortality in an elderly hip fracture cohort, with a possible additional effect of under-resuscitation. Further investigation into a safe intraoperative minimum MAP should be pursued.Level of evidenceLevel III. |
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| Keywords: | Femoral fractures Femoral neck fracture Resuscitation Perioperative period |
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