The impact of complications on quality of life and mortality after hip fracture

Aims: Complications are to be key drivers of poorer outcome but there is limited information on how they influence quality of life (QoL) after hip fracture. The aim of this study was to investigate the relationship between complications, QoL, and mortality after hip fracture. Methods: The World Hip Trauma Evaluation (WHiTE) study is a multi-centre, prospective cohort study that collected data from patients ≥60 years who received operative treatment for their hip fracture. Patients were followed up for 120 days after surgery. The primary and secondary outcomes were health-related QoL (EQ-5D-5L) and mortality, respectively. Linear and logistic regression models were fitted to assess the relationship between complications, EQ-5D-5L, and mortality. Results: Among 24,523 patients with a hip fracture, the mean differences in EQ-5D-5L in patients who had surgery-specific complications were: prosthesis dislocation -0.14 (95% CI: - 0.20 to -0.08); fixation failure 0.00 (95% CI: -0.15 to 0.14); peri-prosthetic or peri-implant fracture -0.08 (95% CI: -0.18 to 0.02); re-operation for any indication -0.09 (95% CI: -0.14 to -0.05); surgical site infection (SSI) -0.06 (95% CI: -0.10 to -0.01); and deep SSI -0.13 (95% CI: -0.20 to -0.07). The mean differences in EQ-5D-5L for the general complications were: acute kidney injury -0.05 (95% CI: -0.07 to -0.02); blood transfusion -0.01 (95% CI: -0.03 to 0.01); lower respiratory tract infection -0.07 (95% CI: -0.09 to -0.05); urinary tract infection 0.01 (95% CI: -0.01 to 0.03); cerebrovascular accident (CVA) -0.17 (95% CI: -0.25 to -0.09); myocardial infarction (MI) -0.14 (95% CI: -0.20 to -0.08); and venous thromboembolism 0.03 (95% CI: -0.02 to 0.08). Conclusions: We observed worse health-related QoL in patients who had a complication after hip fracture. Those who underwent revision surgery or had a prosthesis dislocation or deep SSI experienced similar levels of disability to those with a CVA or MI.