Predictors of mortality in periprosthetic fractures of the hip : results from the national PPF study
Nasser, Ahmed Abdul Hadi Harb Prakash, Rohan Handford, Charles Osman, Khabab Chauhan, Govind Singh Nandra, Rajpal Mahmood, Ansar Dewan, Varun Davidson, Jerome Al-Azzawi, Mohammed
Nasser, Ahmed Abdul Hadi Harb
Prakash, Rohan
Handford, Charles
Osman, Khabab
Chauhan, Govind Singh
Nandra, Rajpal
Mahmood, Ansar
Dewan, Varun
Davidson, Jerome
Al-Azzawi, Mohammed
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Affiliation
The Royal Orthopaedic Hospital; The Birmingham Orthopaedic Network; Birmingham Queen Elizabeth Hospital; St Thomas Hospital; The Whittington Hospital; New Cross Hospital; Walsall Healthcare NHS Trust; Stoke Mandeville Hospital; Sandwell General Hospital; Princess Royal University Hospital; James Paget Hospital; Addenbrooke's Hospital; Princess Royal Hospital; Derriford Hospital; University Hospital Coventry & Warwickshire; Russell's Hall Hospital; Royal Devon and Exeter Hospital; Morriston Hospital; Royal United Hospital; St Mary's Hospital; Worthing Hospital; Ealing Hospital; University Hospital Lewisham; Victoria Hospital; Barnet General Hospital; Salford Royal Hospital; Ulster Hospital; Lister Hospital; Yeovil District Hospital; Bristol Royal Infirmary; University of Birmingham
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Publication date
2023-12-01
Subject
Research Projects
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Abstract
Introduction: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip.
Methods: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period. Univariate and multivariable logistic regression analyses were performed to study the independent correlation between patient, fracture, and treatment factors on mortality.
Results: A total of 1,109 patients were included. The in-hospital mortality rate was 5.3%. Multivariable analyses suggested that age, male sex, abbreviated mental test score (AMTS), pneumonia, renal failure, history of peripheral vascular disease (PVD) and deep surgical site infection were each independently associated with mortality. Each yearly increase in age independently correlates with a 7% increase in mortality (OR 1.07, p=0.019). The odds of mortality was 2.99 times higher for patients diagnosed with pneumonia during their hospital stay [OR 2.99 (95% CI 1.07-8.37) p=0.037], and 7.25 times higher for patients that developed renal failure during their stay [OR 7.25 (95% CI 1.85-28.47) p=0.005]. Patients with history of PVD have a six-fold greater mortality risk (OR 6.06, p=0.003). Mode of treatment was not a significant predictor of mortality.
Conclusion: The in-hospital mortality rate of PPFs around the hip exceeds 5%. The fracture subtype and mode of management are not independent predictors of mortality, while patient factors such as age, AMTS, history of PVD, pneumonia, and renal failure can independently predict mortality. Peri-operative optimisation of modifiable risk factors such as lung and kidney function in patients with PPFs around the hip during their hospital stay is of utmost importance.
Citation
Nasser AAHH, Prakash R, Handford C, Osman K, Chauhan GS, Nandra R, Mahmood A, Dewan V, Davidson J, Al-Azzawi M, Smith C, Gawad M, Palaiologos I, Cuthbert R, Wignadasan W, Banks D, Archer J, Odeh A, Moores T, Tahir M, Brooks M, Biring G, Jordan S, Elahi Z, Shaath M, Veettil M, De C, Handford C, Bansal M, Bawa A, Mattar A, Tandra V, Daadipour A, Taha A, Gangoo S, Srinivasan S, Tarisai M, Budair B, Subbaraman K, Khan F, Gomindes A, Samuel A, Kang N, Kapur K, Mainwaring E, Bridgwater H, Lo A, Ahmed U, Khaleeq T, El-Bakoury A, Rashed R, Hosny H, Yarlagadda R, Keenan J, Hamed A, Riemer B, Qureshi A, Gupta V, Waites M, Bleibleh S, Westacott D, Phillips J, East J, Huntley D, Masud S, Mirza Y, Mishra S, Dunlop D, Khalefa M, Balasubramanian B, Thibbaiah M, Payton O, Berstock J, Deano K, Sarraf K, Logishetty K, Lee G, Subbiah-Ponniah H, Shah N, Venkatesan A, Cheseldene-Culley J, Ayathamattam J, Tross S, Randhawa S, Mohammed F, Ali R, Bird J, Khan K, Akhtar MA, Brunt A, Roupakiotis P, Subramanian P, Bua N, Hakimi M, Bitar S, Najjar MA, Radhakrishnan A, Gamble C, James A, Gilmore C, Dawson D, Sofat R, Antar M, Raghu A, Heaton S, Tawfeek W, Charles C, Burnand H, Duffy S, Taylor L, Magill L, Perry R, Pettitt M, Okoth K, Pinkney T. Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study. Injury. 2023 Dec;54(12):111152
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Article