Understanding One-year Mortality Rates and Comorbidity Burden in Older Adults Following Hip Fracture.

Abstract

Background: Hip fractures impose substantial patient morbidity and burden to health care systems globally, with potentially high and variable 1-year mortality rates. To improve shared decision making when guiding treatment for patients, this study evaluated 1-year mortality rates following hip fractures in the older adult population using a large multicenter live database. The study goal was to determine the recent 1-year mortality rate with contemporary orthogeriatric care strategies.

Materials and methods: A retrospective cohort study was conducted using the TriNetX Research Network. Patients aged 65 to 90 years with an incident hip fracture were identified, excluding those with same-day mortality or previous hip fractures. Cohorts were stratified by sex and 5-year age intervals. One-year all-cause mortality rates following hip fracture and Kaplan-Meier survival (KM) estimates, with log-rank tests, were calculated. Pre-fracture demographic and clinical characteristics were compared between those who succumbed within 1 year and those who survived beyond 1 year.

Results: Among 197,222 included patients, the 1-year mortality rate was 11.6%, with an 86.7% KM estimate of survival. One-year mortality increased with age and was higher in men across all age strata. Patients with 1-year mortality demonstrated a higher baseline comorbidity burden, including neurocognitive, cardiovascular, metabolic, renal, hepatic, and pulmonary diseases and malignancies. Although women succumbing within 1 year had higher rates of certain neurocognitive and metabolic disorders, men had higher rates of chronic ischemic heart disease and chronic kidney disease.

Conclusion: One-year mortality following hip fractures was approximately 12%. Continued monitoring and optimization of multidisciplinary orthogeriatric models and postoperative care may further improve outcomes and survival.