8350 Secular Trend in Hip Fracture Mortality and Predictors of Mortality from the NSQIP Database
Authors: Rhayem C , Ghosn A , Issa Z A , Alwan J , Dimassi H , Haidar R , Fuleihan G El-Hajj 
Published: October 2024

Abstract
Disclosure: C. Rhayem: None. A. Ghosn: None. Z.A. Issa: None. J. Alwan: None. H. Dimassi: None. R. Haidar: None. G. El-Hajj Fuleihan: None.
Introduction: Hip fracture is common among the elderly population and carries major social and financial burdens. Mortality post-hip fracture is substantial, and risk score calculators may provide guidance to patients and potentially modulate surgical approach. Objectives: Describe secular trends in 30-day mortality post hip fracture surgery from the 2011-2017 National Surgical Quality Improvement Program (NSQIP) database. Identify preoperative and upon discharge predictors of 30-day mortality and develop calculators accordingly. Methods: Using SPSS, secular trends were examined by calculating proportions of deaths in each year, survival analysis was generated using Kaplan Meier curve. Logistic regressions were performed for bivariate and for multivariate analyses using backward selection. Calculators were created using Excel. Results: 82,824 cases of hip fracture surgery were identified. The overall 30-day mortality was estimated to be 6.8%. It significantly decreased from 2011 to 2017 by 1.6% (p&lt;0.001) and was lower in females compared to males. Significant preoperative predictors of 30-day mortality were male gender, advancing age, lower BMI, white race, poorer functional health status, steroid use, ascites, bleeding disorder, higher creatinine, lower hematocrit, &gt; 10% weight loss in the past 6 months, chronic diseases such as diabetes, congestive heart failure, and chronic obstructive pulmonary disease, in addition to type of surgery (partial hip hemiarthroplasty compared to intramedullary fixation) and general anesthesia. Significant predictors on discharge of 30-day mortality included all the preoperative predictors except diabetes and the following postoperative predictors: sepsis, cerebrovascular accident/stroke, myocardial infarction, renal failure, pulmonary embolism, pneumonia, unplanned intubation, and readmission. Protective predictors on discharge were bleeding requiring transfusion, unplanned reoperation, longer operation time. The decrease in mortality was paralleled by an increase in intramedullary fixation type of surgery, a decrease in sepsis postoperatively, and a decrease in readmission. Risk score calculators for mortality on admission yielded an area under the curve of 0.742 with a model fit R2 of 0.9764 and for mortality on discharge an area under the curve of 0.813 with a model fit R2 of 0.9917. Discussion/Conclusion: 30-day mortality post hip fracture surgery decreased over time from 2011 till 2017, this could be attributed to the change in some of the significant pre/postoperative predictors of this mortality. Using the developed calculators for 30-day mortality both on admission and discharge could prove instrumental in individualizing risk prediction and guiding patient management. Reference: Sing, C.W., et al., J Bone Miner Res, 2023. 38(8): p. 1064-107
Presentation: 6/2/2024