The impact of gender differences on mortality in elderly patients after hip fracture

Tanja T Prodović; Branko M. Ristić; Dušan D. Vučetić; Dragana I. Ignjatović Ristić

doi:10.2298/VSP161122022P

Tanja T Prodović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Branko M. Ristić University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Dušan D. Vučetić Military Medical Academy, Institute for Transfusiology and Hemobiology, Belgrade, Serbia
Dragana I. Ignjatović Ristić University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP161122022P

Keywords: hip fractures;, aged;, risk factors;, sex;, mortality;, comorbidity;, serbia.

Abstract

Background/Aim. Hip fracture is one of the leading causes of death in elderly population. We evaluated the impact of gender differences on mortality rate in elderly patients with hip fracture. Methods. The study included all hospitalized elderly patients (aged over 65 years) with hip fracture during 2013. The patients were classified into four risk groups in accordance with institutional Şişli Etfal risk factor assessment scale ISERFAS to estimate postoperative mortality. Clinical, laboratory and risk score results were gender matched between survived and deceased patients. Hospital mortality was monitored as well as mortality at intervals of three and six months. The prediction effect of gender and overall risk variables on mortality rate were determined by univariate and multivariate logistic regression analyses. Results. The complete sample included 434 female and 163 male patients. Average age of men was 77.95 years and 79.18 years for women. Femoral neck fracture was more often seen in women (44.5%), but with no statistically significant difference (p = 0.57). Significant difference between the genders in relation to the risk score values was determined (p = 0.024). It was observed that the values of risk score was lower in the female patients and higher in the male patients. Cumulative mortality was 6% during hospital stay, 17.8% after three months and 25% after six months, respectively. In-hospital and six months after the hip fracture, the mortality rates were similar in both genders. The mortality rate was significantly higher in male patients (p = 0.035) three months after the hip fracture. The overall risk observed at all mortality intervals was a significant predictor by itself (p = 0.000). Independent gender prediction effect disappeared in joint effects of patients’ overall risk. Conclusion. Gender can be defined as a significant mortality predictor in patients with hip fracture. A risk assessment system to estimate postoperative mortality for hip fractures would be helpful in planning treatment for each patient.

Author Biographies

Branko M. Ristić, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia

Clinic for Orthopedic Surgery and Traumatology, Clinical Center Kragujevac, Zmaj Jovina 30, 34 000 Kragujevac, Serbia

Dušan D. Vučetić, Military Medical Academy, Institute for Transfusiology and Hemobiology, Belgrade, Serbia

Institute for Transfusiology and Hemobiology, Military Medical Academy, Belgrade, Serbia

Dragana I. Ignjatović Ristić, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia

Psychiatric Clinic, Clinical Center Kragujevac, Zmaj Jovina 30, 34 000 Kragujevac, Serbia

References

REFERENCES

Giversen IM. Time trends of mortality after first hip frac¬tures. Osteoporos Int 2007; 18(6): 721‒32.

Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mor-tality following hip fracture: Trends and geographical varia-tions over the last 40 years. Injury 2008; 39(10): 1157‒63.

Panula J, Pihlajamäki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P, et al. Mortality and cause of death in hip frac¬ture pa-tients aged 65 or older-a population-based study. BMC Mus-culoskelet Disord 2011; 12(1): 105.

Kammerlander C, Gosch M, Kammerlander-Knauer U, Luger TJ, Blauth M, Roth T. Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 2011; 131(10): 1435‒44.

Odumala AO, Iqbal MR, Middleton RG. Failure of closed re-duction after dislocation of Austin Moore hemiarthro¬plasty: an analysis of risk factors a 6-year follow-up study. J Arthro-plasty 2010; 25(5): 781‒4.

Ferrández L. Epidemiology of osteoporotic fractures. In: Fer-nandez L, Herrera A, editors. Osteoporotic fractures. Group Osteoporosis Study and Research (GENIE) of the Spanish Society of Orthopaedic Surgery and Traumatol¬ogy (SECOT). S. A. Madrid: Medical and Marketing Communications; 2006. p. 75‒86.

Rodriguez PFJ. Comparative study of morbidity and mortal¬ity in patients with hip fracture in relation to the time of treat-ment [dissertation]. Cordoba: University of Cordoba; 2006. (Spanish)

Yan L, Zhou B, Prentice A, Wang X, Golden MH. Epidemiol-ogical study of hip fracture in Shenyang, Peo¬ple's Republic of China. Bone 1999; 24(2): 151‒5.

Lyritis GP. Epidemiology of hip fracture: The MEDOS study. Osteoporos Int 1996; 6(3): S11‒5.

Тirado PA. Еvolución of the elderly with hip fracture: experi-ence in the Eastern vallés. [dissertation]. Madrid: University of Madrid; 2013. (Spanish)

Hershkovitz A, Polatov I, Beloosesky Y, Brill S. Factors affect¬ing mortality of frail hip-fractured elderly patients. Arch Gerontol Geriatr 2010; 51(2): 113‒6.

Alarcón AT, González-Montalvo JI. Osteoporotic hip frac¬ture. Predictive factors of short-and long-term functional recovery. An Med Interna 2004; 21(2): 87‒96.

Hannan EL, Magaziner J, Wang JJ, Eastwood EA, Silberz¬weig SB, Gilbert M, et al. Mortality and locomotion 6 months after hospitalization for hip fracture: Risk factors and risk-adjusted hospital outcomes. JAMA 2001; 285(21): 2736‒42.

Ignjatovic Ristic ID, Ristic B, Obradovic Z. Cognitive im¬pairment, hip fractures and risk of mortality in elderly. Psichogeriatria Polska 2005; 2(2): 81‒8.

Donegan DJ, Gay NA, Baldwin K, Morales EE, Esterhai JL, Me-hta S. Use of medical comorbidities to predict complica¬tions after hip fracture surgery in the elderly. J Bone Joint Surg Am 2010; 92(4): 807‒13.

Bhaskar D, Parker MJ. Haematological indices as surrogate markers of factors affecting mortality after hip fracture. In¬jury 2011; 42(2): 178‒82.

Bogosavljević M, Stokić D, Friscić Z, Ristić BM. Unstable inter-trochanteric fractures: How to prevent uncontrolled impac-tion and shortening of the femur. Vojnosanit Pregl 2011; 68(5): 399‒404.

Fransen M, Woodward M, Norton R, Robinson E, Butler M, Camp-bell JA. Excess mortality or institutionalization after hip frac-ture: Men are at greater risk than women. J Am Geriatr Soc 2002; 50(4): 685‒90.

Forsén L, Sogaard AJ, Meyer HE, Edna T, Kopjar B. Survival af-ter hip fracture: Short- and long-term excess mortality accord-ing to age and gender. Osteoporos Int 1999; 10(1): 73‒8.

Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Medical complications and outcomes after hip fracture repair. Arch Intern Med 2002; 162(18): 2053‒7.

Bass E, French DD, Bradham DD, Rubenstein LZ. Risk-ad¬justed mortality rates of elderly veterans with hip frac¬tures. Ann Ep-idemiol 2007; 17(7): 514‒9.

Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Inci¬dence and mortality of hip fractures in the United States. JAMA 2009; 302(14): 1573‒9.

Oztürk I, Toker S, Ertürer E, Aksoy B, Seçkin F. Analysis of risk factors affecting mortality in elderly patients (aged over 65 years). Acta Orthop Traumatol Turc 2008; 42(1): 16‒21.

Autier P, Haentjens P, Bentin J, Baillon JM, Grivegnée AR, Closon MC, et al. Costs induced by hip fractures: a pro¬spective con-trolled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int 2000; 11(5): 373‒80.

Papadimitropoulos EA, Coyte PC, Josse RG, Greenwood CE. Cur-rent and projected rates of hip fracture in Canada. CMAJ 1997; 157(10): 1357‒63.

Löfman O, Berglund K, Larsson L, Toss G. Changes in hip frac-ture epidemiology: Redistribution between ages, gen¬ders and fracture types. Osteoporos Int 2002; 13(1): 18‒25.

Zingmond DS, Melton LJ 3rd, Silverman SL. Increasing hip frac-ture incidence in California Hispanics, 1983 to 2000. Osteo-poros Int 2004; 15(8): 603‒10.

Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predic¬tors for mortality following hip fracture surgery: A sys¬tematic re-view and meta-analysis. Injury 2012; 43(6): 676‒85.

Manzarbeitia J. Hip fractures in the elderly. Rev Esp Econ Salud 2005; 4(4): 209‒10. (Spanish)

Hawkes WG, Wehren L, Orwig D, Hebel RJ, Magaziner J. Gen-der differences in functioning after hip fracture. J Gerontol A Biol Sci Med Sci 2006; 61(5): 495‒9.

Carpintero P, Lopez P, Leon F, Lluch M, Montero M, Aguilera C. Men with hip fractures have poorer nutritional status and sur-vival than women: A prospective study of 165 pa¬tients. Acta Orthop 2005; 76(3): 331‒5.

Alegre-López J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernán-dez-Melón J. Factors associated with mortality and functional disability after hip fracture: An inception co¬hort study. Oste-oporos Int 2005; 16(7): 729‒36.

Pasco JA, Sanders KM, Hoekstra FM, Henry MJ, Nicholson GC, Kotowicz MA. The human cost of fracture. Osteopo¬ros Int 2005; 16(12): 2046‒52.

Lauritzen JB. Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention. Dan Med Bull 1997; 44(2): 155‒68.

Marks R. Physical activity and hip fracture disability: A re-view. J Aging Res 2011; 2011: 741918.

González-Montalvo JI, Alarcón T, Hormigo Sanchez AI. Why do hip fracture patients die. Med Clin (Barc) 2011; 137(8): 355‒60.

Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comor-bidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 2005; 331(7529): 1374‒9.

Bombaci H, Erdogan Ö, Durakbafla O, Ermifl N, Kuyumcu M. Postoperative mortality rates in elderly patients with hip frac-tures: which factors are effective? 12th National Orthopaedics and Traumatology Congress; Oct 31 - Nov 5 2011; Antalya, Turkey. Acta Orthop Traumatol Turc 2011; 45(Suppl 1):111-112. (Turkish)

Cumming RG, Nevitt MC, Cummings SR. Epidemiology of hip fractures. Epidemiol Rev 1997; 19(2): 244‒57.

Melton LJ, Therneau TM, Larson DR. Long-term trends in hip fracture prevalence: The influence of hip fracture inci¬dence and survival. Osteoporos Int 1998; 8(1): 68‒74.

Johnell O. The socioeconomic burden of fractures: today and in the 21st century. Am J Med 1997; 103(2A): 20S‒5S; discus-sion 25S‒6S.