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Outcomes comparison between hip fracture surgery and elective hip replacement: a propensity score-matched analysis on administrative data

  • Pamela Di Giovanni
  • Giuseppe Di Martino
  • Isaia Antonio Luca Zecca
  • Italo Porfilio
  • Ferdinando Romano
  • Tommaso Staniscia
Research Paper

Abstract

Background

Increased life expectancy causes higher prevalence of chronic diseases and greater frailty among older persons. Osteoarthritis and hip fracture are the leading causes of disability among the older persons in high income countries. Recent studies showed that patients undergoing hip fracture surgery have an increased risk of mortality and developing complications. The aim of this study was to compare the occurrence of in-hospital mortality events, complications, and 30-hospital readmissions among patients undergoing hip fracture surgery (HFS) and elective hip replacement (EHR).

Methods

The study considered all hospital admissions for HFS and EHR performed from 2006 to 2015 in Abruzzo region, Italy. Data were collected from hospital discharge records. To compare outcomes between HFS and EHR, a propensity score matching procedure was performed. Odds ratios with 95% confidence intervals for primary and secondary outcomes were computed using logistic regression models.

Results

A total of 32,248 patients were selected: 23,075 underwent HFS and 9173 underwent EHR. After matching, 18,078 patients were included in the analyses (9039 patients who underwent HFS and 9039 patients who underwent HER). In the matched population, HFS patients showed an increased risk of in-hospital mortality (OR 2.03; 95% CI 1.58–2.61) and 30-day hospital readmission (OR 1.97; 95% CI 1.85–2.09). A sensitivity analysis performed on patients younger than 65 years of age confirmed these findings.

Conclusions

In a cohort of Italian patients, hip fracture surgery was associated with a higher risk of in-hospital mortality and 30-day readmission when compared to elective hip replacement.

Keywords

Hip Fracture Hip Replacement Propensity score Outcomes Italy 

Notes

Acknowledgements

The authors are very grateful to Angelo Muraglia and Italo Di Giuseppe (Dipartimento della Salute e del Welfare, Regione Abruzzo, Italy) for helping in data collection and to Marzia Iasenza (PhD in English Linguistics) for reviewing the English manuscript.

Funding

Funding information is not applicable.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted in conformity with the regulations on data management of the Regional Health Authority of Abruzzo and with the Italian Law on privacy (Art. 20-21 DL 196/2003) published on the Official Journal n. 190 of August 14, 2004. Data were encrypted prior to the analysis at the regional statistical office, where each patient was assigned a unique identifier. This identifier eliminates the possibility to trace the patient’s identity. The usage of this database was approved by the Department of Health and Welfare of Abruzzo Region.

Informed consent

According to the Italian laws, no written informed consent is required when the data are anonymous.

Supplementary material

41999_2018_146_MOESM1_ESM.docx (98 kb)
Supplementary material 1 (DOCX 97 kb)

References

  1. 1.
    Tarantino U, Piscitelli P, Feola M et al (2018) Decreasing trend of hip fractures incidence in Italy between 2007 and 2014: epidemiological changes due to population aging. Arch Osteoporos 13(1):23.  https://doi.org/10.1007/s11657-018-0423-y CrossRefPubMedGoogle Scholar
  2. 2.
    Ireland AWKP, Cumming RG (2016) Associations between hospital-based rehabilitation for hip fracture and two-year outcomes for mortality and independent living: an Australian database study of 1,724 elderly community-dwelling patients. J Rehabil Med 48(7):625–631CrossRefPubMedGoogle Scholar
  3. 3.
    Desborough JP (1999) Physiological responses to surgery and traum. In: Hemmings Jr HC, Hopkins PM (eds), Foundations of anaesthesia, Mosby, London, pp 713–720Google Scholar
  4. 4.
    Ford S (2014) Outcome differences after elective or emergency hip operations. Anaesthesia 69(6):643CrossRefPubMedGoogle Scholar
  5. 5.
    Weycker D, Edelsberg J, Barron R (2017) Predictors of near-term fracture in osteoporotic women aged ≥ 65 years, based on data from the study of osteoporotic fractures. Osteoporos Int 28(9):2565–2571.  https://doi.org/10.1007/s00198-017-4103-39) CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Barzilay JI, Bůžková P, Kizer JR et al (2016) Fibrosis markers, hip fracture risk, and bone density in older adults. Osteoporos Int 27(2):815–820.  https://doi.org/10.1007/s00198-015-3269-9 (Epub 2015 Aug 13)CrossRefPubMedGoogle Scholar
  7. 7.
    Desborough JP (2000) The stress response to trauma and surgery. Br J Anaesth 85(1):109–117CrossRefPubMedGoogle Scholar
  8. 8.
    Le Manach Y, Collins G, Bhandari M et al (2015) Outcomes after hip fracture surgery compared with elective total hip replacement. JAMA 314(11):1159–1166.  https://doi.org/10.1001/jama.2015.10842 CrossRefPubMedGoogle Scholar
  9. 9.
    Parsons LS (2018) Reducing bias in a propensity scorematched-pair sample using greedy matching techniques. In: Proceedings of the twenty-sixth annual SAS users group international conference. Cary, NC: SAS Institute. Available: http://www2.sas.com/proceedings/sugi26/p214-26.pdf. Accessed 10 Jan 2018
  10. 10.
    Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28(25):3083–3107CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Haentjens P, Magaziner J, Colón-Emeric CS et al (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152(6):380–390CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Sassoon A, D’ApuzzoM Sems S, Cass J, Mabry T (2013) Total hip arthroplasty for femoral neck fracture: comparing in-hospital mortality, complications, and disposition to an elective patient population. J Arthroplasty 28(9):1659–1662CrossRefPubMedGoogle Scholar
  13. 13.
    Boddaert J, Cohen-Bittan J, Khiami F et al (2014) Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS ONE 9(1):e83795CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Svensén CH (2004) Vascular endothelial growth factor (VEGF) in plasma increases after hip surgery. J Clin Anesth 16(6):435–439CrossRefPubMedGoogle Scholar
  15. 15.
    Hirsch J, Vacas S, Terrando N et al (2016) Perioperative cerebrospinal fluid and plasma inflammatory markers after orthopedic surgery. J Neuroinflammation 13(1):211.  https://doi.org/10.1186/s12974-016-0681-9 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Esmon CT (2005) The interactions between inflammation and coagulation. Br J Haematol 131(4):417–430CrossRefPubMedGoogle Scholar
  17. 17.
    Cohen MJ, Christie SA (2017) Coagulopathy of Trauma. Crit Care Clin 33(1):101–118.  https://doi.org/10.1016/j.ccc.2016.08.003 CrossRefPubMedGoogle Scholar
  18. 18.
    Tsangari H, Findlay DM, Kuliwaba JS, Atkins GJ, Fazzalari NL (2004) Increased expression of IL-6 and RANK mRNA in human trabecular bone from fragility fracture of the femoral neck. Bone 35(1):334–342CrossRefPubMedGoogle Scholar
  19. 19.
    Heras M, Fernandez-Reyes MJ, Guerrero MT et al (2012) Acute renal failure predictors in elderly patients with chronic kidney disease. Nefrologia 32(6):819–823PubMedGoogle Scholar
  20. 20.
    Schissler MM, Zaidi S, Kumar H et al (2013) Characteristics and outcomes in community-acquired versus hospital-acquired acute kidney injury. Nephrology (Carlton) 18(3):183–187CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  1. 1.Department of Pharmacy“G. d’Annunzio” University of Chieti-PescaraChietiItaly
  2. 2.School of Hygiene and Preventive Medicine“G. d’Annunzio” University of Chieti-PescaraChietiItaly
  3. 3.Department of Public Health and Infectious Diseases“La Sapienza” University of RomeRomeItaly
  4. 4.Department of Medicine and Ageing Sciences“G. d’Annunzio” University of Chieti-PescaraChietiItaly

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