Evaluating the Severity Spectrum: A Hierarchical Analysis of Complications During Hip Fracture Admission Associated With Mortality

Objectives: To determine which in-hospital complications after the operative treatment of hip fractures are associated with increased in-patient, 30-day, and 1-year mortality.

Design: Retrospective study.

Setting: A single academic medical center and a Level 1 Trauma Center.

Patient selection criteria: All patients who were operatively treated for hip fractures (Orthopaedic Trauma Association/AO 31A, 31B and Vancouver A, B, and C periprosthetic fractures) at a single center between October, 2014, and June, 2023.

Outcome measures and comparisons: Occurrence of an in-hospital complication was recorded. Cohorts were based on mortality time points (during admission, 30 days, and 1 year) and compared with patients who were alive at those time points to determine which in-hospital complications were most associated with mortality. Correlation analysis was performed between patients who died and those who were alive at each time point.

Results: A total of 3134 patients (average age of 79.6 years, range 18-104 years and 66.6% women) met inclusion for this study. The overall mortality rate during admission, 30 days, and 1 year was found to be 1.6%, 3.9%, and 11.1%, respectively. Sepsis was the complication most associated with increased in-hospital mortality (odds ratio [OR] 7.79, 95% confidence interval [CI], 3.22-18.82, P < 0.001) compared with other in-hospital complications. Compared with other in-hospital complications, stroke was the complication most associated with 30-day mortality (OR 7.95, 95% CI, 1.82-34.68, P < 0.001). Myocardial infarction was the complication most associated with 1-year mortality (OR 2.86, 95% CI, 1.21-6.77, P = 0.017) compared with other in-hospital complications.

Conclusions: Postoperative sepsis, stroke, and myocardial infraction were the 3 complications most associated with mortality during admission, 30-day mortality, and 1-year mortality, respectively, during the operative treatment of hip fractures.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.