AVOIDABLE OR UNAVOIDABLE DEATHS IN FRACTURED NECK OF FEMUR PATIENTS

Abstract

Patients who suffer a fracture of the proximal femur are high risk for developing venous thromboembolism. They require effective anti-thrombotic prophylaxis. In an audit of 11,900 patients a mortality of 17% occurred 3 months after the injury. Although post mortem examination was rare, it was estimated that nearly 50% of 753 deaths were thrombosis related, 6.9% specifically attributed to pulmonary embolus. It is likely that many of the other deaths, attributed to various respiratory problems were also at least in part due to PE. Comparing the data with actuarial tables demonstrated an excess mortality in both gender and in nearly all age groups. In a second audit, although many patients were receiving some form of prophylaxis, many were given ineffective agents and probably using an ineffective regime. In many patients a fracture of the proximal femur is regarded as a terminal event. However, the data from these 2 audits would suggest that many of these patients are dying unnecessarily and that effective prophylaxis would reduce the risk of death. Chemical prophylaxis commenced immediately after surgery and continued for 5 weeks would be appropriate.