Outcomes after hip fracture surgery compared with elective total hip replacement

Abstract

IMPORTANCE Patients undergoing surgery for a hip fracture have a higher risk of mortality and major complications compared with patients undergoing an elective total hip replacement (THR) operation. The effect of older age and comorbidities associated with hip fracture on this increased perioperative risk is unknown. OBJECTIVE To determine if there was a difference in hospital mortality among patients who underwent hip fracture surgery relative to an elective THR, after adjustment for age, sex, and preoperative comorbidities. DESIGN, SETTING, AND PARTICIPANTS Using the French National Hospital Discharge Database from January 2010 to December 2013, patients older than 45 years undergoing hip surgery at French hospitals were included. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), codes were used to determine patients' comorbidities and complications after surgery. A population matched for age, sex, and preoperative comorbidities of patients who underwent elective THR or hip fracture surgery was created using a multivariable logistic model and a greedy matching algorithm with a 1:1 ratio. EXPOSURE Hip fracture. MAIN OUTCOMES AND MEASURES Postoperative in-hospital mortality. RESULTS A total of 690 995 eligible patients were included from 864 centers in France. Patients undergoing elective THR surgery (n = 371 191) were younger, more commonly men, and had less comorbidity compared with patients undergoing hip fracture surgery. Following hip fracture surgery (n = 319 804), 10 931 patients (3.42%) died before hospital discharge and 669 patients (0.18%) died after elective THR. Multivariable analysis of the matched populations (n = 234 314) demonstrated a higher risk of mortality (1.82%for hip fracture surgery vs 0.31% for elective THR; absolute risk increase, 1.51% [95%CI, 1.46%-1.55%]; relative risk [RR], 5.88 [95%CI, 5.26-6.58]; P < .001) and of major postoperative complications (5.88%for hip fracture surgery vs 2.34%for elective THR; absolute risk increase, 3.54%[95%CI, 3.50%-3.59%]; RR, 2.50 [95%CI, 2.40-2.62]; P < .001) among patients undergoing hip fracture surgery. CONCLUSIONS AND RELEVANCE In a large cohort of French patients, hip fracture surgery compared with elective THR was associated with a higher risk of in-hospital mortality after adjustment for age, sex, and measured comorbidities. Further studies are needed to define the causes for these differences.