Increased postoperative complication risk in elderly hip fracture patients with cerebrovascular disorders: A propensity score-matched nationwide cohort study

Background

Cerebrovascular disorders are known risk factors for hip fractures in the elderly. However, their impact on postoperative complications following hip fracture surgery remains insufficiently studied.

Methods

This retrospective cohort study utilized the Japanese Diagnosis Procedure Combination (DPC) database from April 2016 to March 2022. Patients aged ≥65 years who underwent surgical treatment for hip fractures were included. Individuals with cerebrovascular disorders were identified via ICD-10 codes (I60–I64). Propensity score matching (1:1) was performed based on age, sex, BMI, Charlson Comorbidity Index, anesthesia type, fracture classification, and surgical procedure. Outcomes included venous thromboembolism, urinary tract infection, pneumonia, postoperative cognitive dysfunction, and in-hospital mortality. Secondary outcomes were length of hospital stay, blood transfusion volume, and use of anti-osteoporotic agents.

Results

Out of 474,293 eligible patients, 46,158 matched pairs were analyzed. Multivariate logistic regression showed cerebrovascular disorders were independently associated with higher risks of pneumonia (adjusted OR: 1.515; 95 % CI: 1.418–1.619), urinary tract infection (adjusted OR: 1.336; 95 % CI: 1.245–1.433), and cognitive dysfunction (adjusted OR: 1.237; 95 % CI: 1.117–1.371). No significant difference in in-hospital mortality was observed. Patients with cerebrovascular disorders had longer hospital stays (38.2 vs. 35.6 days).

Conclusions

Cerebrovascular disorders are associated with increased postoperative infectious and cognitive complications in elderly hip fracture patients. These findings underscore the importance of incorporating cerebrovascular history into perioperative risk assessment and optimizing multidisciplinary care strategies.