Session X - Pelvis/Geriatrics

Sat., 10/20/01 Pelvis/Geriatrics, Paper #63, 11:05 AM

Mortality Risk after Hip Fracture: A Prospective Study

Jeffrey Richmond, MD, Gina B. Aharonoff, MPH, Joseph D. Zuckerman, MD, Kenneth J. Koval, MD, New York University-Hospital for Joint Diseases, New York, NY

Purpose: The greatest mortality risk after hip fracture has been demonstrated to be within the first six months of fracture, and some studies report that the risk approaches expected mortality after 6 months. However, more recent studies have demonstrated that an increased risk of mortality may persist for several years after the fracture. We assessed the excess mortality associated with hip fracture at up to two years after the injury.

Methods: All patients with a hip fracture who were admitted to our institution over a 10-year period were evaluated. Criteria for inclusion included: Caucasian race, age 65 or older, previously ambulatory and home dwelling. Patients were followed prospectively in order to determine the mortality risk associated with hip fracture over a 2-year follow-up period. Mortality was compared to that of a standardized population and Standardized Mortality Ratios (SMR) were calculated.

Results: A total of 836 patients met the inclusion criteria. The mortality risk was highest within the first 3 months after fracture, with SMR approaching that of the control population by 2 years. Patients who were age 65 to 84 years had a higher mortality risk when compared with patients age 85. The American Society of Anesthesiologists (ASA) classification of 3 or 4 was predictive of increased mortality risk in younger patients, with these patients having triple the mortality risk when compared to the reference population at the 2-year follow-up. More elderly patients had minimal excess mortality associated with hip fracture at one and two year follow-up, regardless of ASA classification.

Conclusion: The data demonstrated that hip fracture is not associated with significant excess mortality among patients older than age 85. Among younger patients, however, those with ASA classifications of 3 or 4 have a significant excess mortality after hip fracture that persists up to two years after injury.