Risk factors associated with the development of complications after hip fracture
Goh EL., Png ME., Metcalfe D., Achten J., Appelbe D., Griffin X., Cook J., Costa M.
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.