Trends and Predictors of 30-Day Mortality After Hip Fracture Surgery (2011-2017)

Overview

Analysis of 84,824 hip fracture surgeries from the NSQIP database showed a significant decrease in 30-day mortality from 8.1% in 2011 to 6.5% in 2017. Key preoperative and discharge predictors of mortality were identified, and risk calculators with good predictive performance were developed to aid clinical decision-making.

Background

Hip fractures are a major cause of morbidity and mortality in the elderly, with an estimated 10 million cases annually worldwide. Surgical intervention within 48 hours is the standard of care to improve outcomes. Despite the high mortality associated with hip fractures, data on temporal trends and predictive factors for postoperative mortality remain limited. The NSQIP database provides a robust source to evaluate these trends and develop risk prediction models.

Data Highlights

Key Findings

• The overall 30-day mortality rate after hip fracture surgery was 6.8% across 2011-2017.
• Mortality decreased significantly from 8.1% in 2011 to 6.5% in 2017 (P < .001).
• Preoperative predictors of mortality included male sex, advanced age, lower BMI, White race, poor functional status, elevated creatinine, low hematocrit, recent significant weight loss, congestive heart failure, and chronic obstructive pulmonary disease.
• On-discharge predictors added unplanned intubation, cerebrovascular accident, myocardial infarction, and pneumonia to the preoperative factors, with some exceptions.
• The preoperative risk calculator with 10 variables had an AUC of 0.739 and R2 of 0.9716; the on-discharge calculator with 11 variables had an AUC of 0.800 and R2 of 0.9924.

Clinical Implications

The observed decline in 30-day mortality suggests improvements in perioperative care for hip fracture patients. The identified predictors, many of which are readily available clinical variables, can help clinicians stratify risk preoperatively and at discharge. The developed risk calculators may support informed surgical decision-making and tailored postoperative management to further reduce mortality.

Conclusion

Thirty-day mortality following hip fracture surgery has decreased significantly over recent years. Validated risk prediction models based on clinical factors can enhance prognostication and guide care strategies in this high-risk population.

References

1. Xu et al. 2020 -- Systematic Review of Hip Fracture Mortality Predictors
2. American College of Surgeons NSQIP Database