En Lin Goh, May Ee Png, David Metcalfe, Juul Achten, Duncan Appelbe, Xavier L Griffin, Jonathan A Cook, Matthew L Costa, Michael Barrett, Peter Hull, David Melling, Jonathan Kosy, Charalambos P Charalambous, Oliver Keast- Butler, Paul Magill, Rathan Yarlagadda, Girish Vashista, Terence Savaridas, Seb Sturridge, Graham Smith, Kishore Dasari, Deepu Bhaskar, Stefan Bajada, Ewan Bigsby, Ansar Mahmood, Mark Dunbar, Andrea Jimenez, Ryan Wood, James Penny, William Eardley, Robert Handley, Suresh Srinivasan, Matt Gee, Ashwin Kulkarni, John Davison, Mohammad Maqsood, Amit Sharma, Chris Peach, Ahsan Sheeraz, Piers Page, Andrew Kelly, Iain McNamara, Lee Longstaff, Mike Reed, Iain Moppett, Ayman Sorial, Theophilus Joachim, Aaron Ng, Kieran Gallagher, Mark Farrar, Ad Ghande, Jonathan Bird, Shyam Rajagopalan, Andrew McAndrew, Andrew Sloan, Rory Middleton, Ian Dos Remedios, Damian McClelland, Benedict Rogers, James Berstock, Sharad Bhatnagar, Owen Diamond, Paul Fearon, Inder Gill, Doug Dunlop, Tim Chesser, Mehool Acharya, Deepak Sree, Johnathan Craik, David Hutchinson, David Johnson, Mosab Elgalli, Paul Dixon, Pregash Ellapparadja, Guy Slater, Jakub Kozdryk, Jonathan Young, Khitish Mohanty Ben Ollivere, Mohammad Faisal, Callum Clark, Baljinder Dhinsa, Ibrahim Malek, Sam Heaton, Oliver Blocker, Kanthan Theivendran
{"title":"Risk factors associated with the development of complications after a hip fracture.","authors":"En Lin Goh, May Ee Png, David Metcalfe, Juul Achten, Duncan Appelbe, Xavier L Griffin, Jonathan A Cook, Matthew L Costa, Michael Barrett, Peter Hull, David Melling, Jonathan Kosy, Charalambos P Charalambous, Oliver Keast- Butler, Paul Magill, Rathan Yarlagadda, Girish Vashista, Terence Savaridas, Seb Sturridge, Graham Smith, Kishore Dasari, Deepu Bhaskar, Stefan Bajada, Ewan Bigsby, Ansar Mahmood, Mark Dunbar, Andrea Jimenez, Ryan Wood, James Penny, William Eardley, Robert Handley, Suresh Srinivasan, Matt Gee, Ashwin Kulkarni, John Davison, Mohammad Maqsood, Amit Sharma, Chris Peach, Ahsan Sheeraz, Piers Page, Andrew Kelly, Iain McNamara, Lee Longstaff, Mike Reed, Iain Moppett, Ayman Sorial, Theophilus Joachim, Aaron Ng, Kieran Gallagher, Mark Farrar, Ad Ghande, Jonathan Bird, Shyam Rajagopalan, Andrew McAndrew, Andrew Sloan, Rory Middleton, Ian Dos Remedios, Damian McClelland, Benedict Rogers, James Berstock, Sharad Bhatnagar, Owen Diamond, Paul Fearon, Inder Gill, Doug Dunlop, Tim Chesser, Mehool Acharya, Deepak Sree, Johnathan Craik, David Hutchinson, David Johnson, Mosab Elgalli, Paul Dixon, Pregash Ellapparadja, Guy Slater, Jakub Kozdryk, Jonathan Young, Khitish Mohanty Ben Ollivere, Mohammad Faisal, Callum Clark, Baljinder Dhinsa, Ibrahim Malek, Sam Heaton, Oliver Blocker, Kanthan Theivendran","doi":"10.1302/0301-620X.107B9.BJJ-2024-0981.R2","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Mortality after a hip fracture has declined in recent years, but the risk of complications remains high. The aim of this study was to identify non-modifiable and, specifically, modifiable factors associated with the development of complications after hip fracture.</p><p><strong>Methods: </strong>This was a multicentre, prospective cohort study of adults aged ≥ 60 years with a hip fracture who were treated in 77 hospitals in England, Wales, and Northern Ireland between July 2014 and November 2021. A total of 24,523 patients were enrolled into the study. Cox proportional hazards regression models were used to assess associations between prespecified (a priori) covariates and the development of surgery-specific and general complications at 120 days, postoperatively.</p><p><strong>Results: </strong>For surgery-specific complications, male sex was associated with reoperation (hazard ratio (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)); American Society of Anesthesiologists (ASA) grade ≥ III with prosthetic dislocation (HR 2.19 (95% CI 1.40 to 3.41)), reoperation (HR 1.35 (95% CI 1.06 to 1.72)), and surgical site infection (SSI) (HR 1.26 (95% CI 1.02 to 1.56)); treatment with a cephalomedullary nail with periprosthetic or peri-implant fracture (HR 4.09 (95% CI 1.62 to 10.32)) and reoperation (HR 1.94 (95% CI 1.29 to 2.92)); and treatment with total hip arthroplasty (THA) with prosthetic 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)), the requirement of a 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 ≥ III with AKI (HR 1.52 (95% CI 1.18 to 1.95)), the requirement of a 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 mobilization 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)).</p><p><strong>Conclusion: </strong>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 seen in these groups. We also identified a number of potentially modifiable treatment-related factors which may influence the development of complications and which warrant further investigation.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 9","pages":"950-956"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.107B9.BJJ-2024-0981.R2","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Aims: Mortality after a hip fracture has declined in recent years, but the risk of complications remains high. The aim of this study was to identify non-modifiable and, specifically, modifiable factors associated with the development of complications after hip fracture.
Methods: This was a multicentre, prospective cohort study of adults aged ≥ 60 years with a hip fracture who were treated in 77 hospitals in England, Wales, and Northern Ireland between July 2014 and November 2021. A total of 24,523 patients were enrolled into the study. Cox proportional hazards regression models were used to assess associations between prespecified (a priori) covariates and the development of surgery-specific and general complications at 120 days, postoperatively.
Results: For surgery-specific complications, male sex was associated with reoperation (hazard ratio (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)); American Society of Anesthesiologists (ASA) grade ≥ III with prosthetic dislocation (HR 2.19 (95% CI 1.40 to 3.41)), reoperation (HR 1.35 (95% CI 1.06 to 1.72)), and surgical site infection (SSI) (HR 1.26 (95% CI 1.02 to 1.56)); treatment with a cephalomedullary nail with periprosthetic or peri-implant fracture (HR 4.09 (95% CI 1.62 to 10.32)) and reoperation (HR 1.94 (95% CI 1.29 to 2.92)); and treatment with total hip arthroplasty (THA) with prosthetic 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)), the requirement of a 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 ≥ III with AKI (HR 1.52 (95% CI 1.18 to 1.95)), the requirement of a 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 mobilization 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)).
Conclusion: 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 seen in these groups. We also identified a number of potentially modifiable treatment-related factors which may influence the development of complications and which warrant further investigation.
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