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Aims: Mortality after hip fracture has declined in recent years but the risk of complications remains high. This study aims to identify non-modifiable and specifically, modifiable factors associated with the development of complications after hip fracture. Methods: A multi-centre, prospective cohort study of adults aged 60 years and older with a hip fracture across 77 representative hospitals in England, Wales and Northern Ireland between 2015 to 2022. Cox-proportional hazards regression models was used to assess associations between pre-specified (a priori) co-variates and the development of surgeryspecific and general complications at 120-days. Results: There were 24,523 patients with a hip fracture enrolled into the study. For surgeryspecific complications, male sex was associated with re-operation (HR: 1.23, 95% CI: 1.01 to 1.51) and surgical site infection (SSI) (HR: 1.20, 95% CI: 1.00 to 1.43); ASA grade ≥3 with prosthesis dislocation (HR: 2.19, 95% CI: 1.40 to 3.41), re-operation (HR: 1.35, 95% CI: 1.06 to 1.72) and SSI (HR: 1.26, 95% CI: 1.02 to 1.56); treatment with cephalomedullary nail with peri-prosthetic or peri-implant fracture (HR: 4.09, 95% CI: 1.62 to 10.32) and re-operation (HR: 1.94, 95% CI: 1.29 to 2.92); and treatment with total hip arthroplasty with prosthesis dislocation (HR: 2.43, 95% CI: 1.54 to 3.82). For general complications, age was associated with acute kidney injury (AKI) (HR: 1.04, 95% CI: 1.03 to 1.05), blood transfusion (HR: 1.02, 95% CI: 1.01 to 1.02), lower respiratory tract infection (LRTI) (HR: 1.02, 95% CI: 1.01 to 1.03) and urinary tract infection (UTI) (HR: 1.02, 95% CI 1.01 to 1.02); ASA grade ≥3 with AKI (HR: 1.52, 95% CI: 1.18 to 1.95), blood transfusion (HR: 1.35, 95% CI: 1.16 to 1.58), LRTI (HR: 2.02, 95% CI: 1.72 to 2.37) and UTI (HR: 1.33, 95% CI: 1.13 to 1.56); male sex with AKI (HR: 1.30, 95% CI: 1.09 to 1.55), and LRTI (HR: 1.33, 95% CI: 1.20 to 1.48); delayed mobilisation with AKI (HR: 1.68, 95% CI: 1.13 to 2.44), LRTI (HR: 1.96, 95% CI: 1.75 to 2.19), UTI (HR: 1.52, 95% CI: 1.32 to 1.74), myocardial infarction (MI) (HR: 2.05, 95% CI: 1.35 to 3.10) and pulmonary embolism (HR: 1.70, 95% CI: 1.05 to 2.74); and delayed surgery with MI (HR: 1.66, 95% CI: 1.13 to 2.44). Conclusions: Patient-related factors such as increasing age, male sex and higher comorbidity were associated with a number of complications, which may explain the higher mortality and worse recovery observed in these groups. We also identified a number of potentially modifiable treatment-related factors that may influence the development of complications that warrant further investigation. 

Type

Journal article

Journal

Bone and joint journal

Publisher

British Editorial Society of Bone and Joint Surgery

Publication Date

07/05/2025