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Open Access Research article

High short-term and long-term excess mortality in geriatric patients after hip fracture: a prospective cohort study in Taiwan

Li-Wei Hung1, Wo-Jan Tseng2, Guey-Shiun Huang3 and Jinn Lin1*

Author Affiliations

1 Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, No.7 Chung-Shan S. Rd, Taipei, Taiwan, 100

2 Department of Orthopedics Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan, No.25, Lane 442, Sec. 1, Jingguo Rd., Hsinchu, Taiwan

3 Department of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan, No.1 Jen-Ai Rd, Sec. 1, Taipei, Taiwan, 100

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BMC Musculoskeletal Disorders 2014, 15:151  doi:10.1186/1471-2474-15-151

Published: 9 May 2014

Abstract

Background

Hip fracture has a high mortality rate, but the actual level of long-term excess mortality and its impact on population-wide mortality remains controversial. The present prospective study investigated short- and long-term excess mortality after hip fractures with adjustment of other risk factors. We calculated the population attributable risk proportion (PARP) to assess the impact of each risk factor on excess mortality.

Methods

We recruited 217 elders with hip fractures and 215 age- and sex-matched patients without fractures from the geriatric department of the same hospital. The mean follow-up time was 46.1 months (range: 35 to 57 months). We recorded data on 55 covariates, including baseline details about health, function, and bone mineral density. We used the multivariate Cox proportional hazards model to analyze hazard ratios (HRs) of short-term (<12 months follow-up) and long-term (≧12 months follow-up) excess mortality for each covariate and calculated their PARP.

Results

Patients with hip fractures had a higher short-term mortality than non-fractured patients, and the long-term excess mortality associated with hip fracture remained high. The significant risk factors for short-term mortality were hip fracture, comorbidities, and lower (below cutoff) Mini Mental State Examination score with HRs of 2.4, 2.3, and 2.3, respectively. Their PARPs were 44.7%, 38.1%, and 34.3%, respectively. The significant risk factors for long-term mortality were hip fracture (HR: 2.7; PARP: 48.0%), lower T-score (HR: 3.3; PARP: 36.2%), lower body mass index (HR: 2.5; PARP: 42.8%), comorbidities (HR: 2.1; PARP: 34.8%), difficulty in activities of daily living (HR: 1.9; PARP: 31.8%), and smoking (HR: 2.5; PARP: 19.2%).

Conclusions

After comprehensive adjustment, hip fracture was a significant risk factor and contributed the most to long-term as well as short-term excess mortality. Its adequate prevention and treatment should be targeted.

Keywords:
Hip fracture; Excess mortality; Osteoporosis; Elderly population