The aims of this study were to identify the early
in-hospital mortality rate after hip fracture, identify factors associated
with this mortality, and identify the cause of death in these patients.
A retrospective cohort study was performed on 4426 patients admitted
to our institution between the 1 January 2006 and 31 December 2013
with a hip fracture (1128 male (26%), mean age 82.0 years (60 to
105)). Admissions increased annually, but despite this 30-day mortality
decreased from 12.1% to 6.5%; 77% of these were in-hospital deaths.
Male gender (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.3
to 3.0), increasing age (age ≥ 91; OR 4.1, 95% CI 1.4 to 12.2) and
comorbidity (American Society of Anesthesiologists grades 3 to 5;
OR 4.2, 95% CI 2.0 to 8.7) were independently and significantly
associated with increased odds of in-hospital mortality. From 220
post-mortem reports, the most common causes of death were respiratory
infections (35%), ischaemic heart disease (21%), and cardiac failure
(13%). A sub-group of hip fracture patients at highest risk of early
death can be identified with these risk factors, and the knowledge
of the causes of death can be used to inform service improvements
and the development of a more didactic care pathway, so that multidisciplinary
intervention can be focused for this sub-group in order to improve
their outcome. Cite this article:
Between November 1994 and June 1999, 35 patients referred to our Problem Fracture Service with chronic diaphyseal osteomyelitis were treated using a closed double-lumen suction irrigation system after reaming and arthroscopic debridement of the intramedullary canal. This is a modified system based on that of Lautenbach. Between June and July 2007 the patients were reviewed by postal questionnaire and telephone and from the case notes. At a mean follow-up of 101 months (2 to 150), 26 had no evidence of recurrence and four had died from unrelated causes with no evidence of recurrent infection. One had been lost to follow-up at two months and was therefore excluded. Four had persisting problems with sinus discharge and one had his limb amputated for recurrent metaplastic change. Our results represent a clearance of infection of 85.3% (29 of 34), with recurrence in 11.8% (4 of 34). They are comparable to the results of the Papineau and Belfast techniques, but with considerably less surgical insult to the patient.
Obesity is increasing among patients requesting total hip replacement. Obesity is often considered though, a relative contraindication to arthroplasty surgery due to difficult access, greater blood loss, oozy wounds, poor mobilisation and delayed discharge. We have attempted to demonstrate the evidence for this. Patients were evaluated preoperatively with regards to their height and weight to allow a body mass index (BMI) to be calculated. The length of inpatient stay was then monitored and early postoperative complications recorded. This data was used to assess if obesity or age could be used to predict a prolonged hospital stay caused by poor rehabilitation and early post operative complications. The results of 70 consecutive patients between 1999–2001 are reported. The average age was 69.3 with a range of 46.5–85.4 years. The sex distribution was approximately 2:1 female to male (N=48:22 respectively). Two patients were identified as being under their recommended weight, 24 as healthy, 26 as over weight and 18 as obese. Urinary tract infection was confirmed by microbiological culture in 6 patients, superficial wound swab grew organisms in 5 patients while 2 developed culture positive chest infections. No thromboembolic events were recorded (Stroke, Deep Vein Thrombosis, Pulmonary Embolism) however one patient died of ischemic heart disease (BMI 35 obese). Data was examined by an Excel statistical package and an ANOVA plot produced. No statistical relationship was found between obesity and infective postoperative problems. No delay in discharge was found when BMI was considered, R2 value of 0.0015, F-significance 0.75. When age alone was considered R2 value of 0.003 and F-significance of 0.65 was recorded. When age and obesity were considered together R2 was 0.005 and F-significance 0.57. We find no evidence of increased rates of early postoperative complications or delayed hospital discharge in obese patients with a BMI less than 40.
