Incidence, risk factors and case fatality rate for hip fracture in Chile: A cross-sectional study based on 2017 national registries

Mortality following proximal femoral fractures in elderly patients: a large retrospective cohort study of incidence and risk factors

BACKGROUND

Global prevalence of osteoporosis and fragility fractures is increasing due to the aging population. Proximal femoral fractures are among the most common orthopedic conditions in elderly that significantly cause health deterioration and mortality. Here, we aimed to evaluate the mortality rates and risk factors, besides the functional outcomes after these injuries.

METHODS

In a retrospective cohort study, all patients admitted with a femoral neck or intertrochanteric fracture between 2016 and the end of 2018 were enrolled in this study. Medical records were reviewed to include patients over 60 years of age who had a proximal femoral fracture and had a complete medical record and radiographs. Exclusion criteria included patients with pathological fractures, cancer under active treatment, follow-up loss, and patient access loss. Demographic and clinical features of patients alongside the details of fracture and patient management were recorded and analyzed. In-hospital and post-discharge mortalities due to included types of fractures at one and 12 months were the primary outcome. Modified Harris Hip Scores (mHHS) was the measure of functional outcome.

RESULTS

A total of 788 patients including 412 females (52.3%) and 376 males (47.7%) with a mean age of 76.05 ± 10.01 years were included in this study. Among patients, 573 (72.7%) had an intertrochanteric fracture, while 215 (27.3%) had a femoral neck fracture, and 97.1% of all received surgical treatment. With a mean follow-up of 33.31 months, overall mortality rate was 33.1%, and 5.7% one-month and 20.2% 12-months rates. Analysis of 1-month mortality showed a significant mortality difference in patients operated after 48 h of fracture (p = 0.01) and in patients with American Society of Anesthesiologists (ASA) scores of 3-4 compared to ASA scores of 1-2 (p = 0.001). One-year mortality data showed that the mortality rate in femoral neck fractures was lower compared to other types of fracture. Surgical delay of > 48 h, ASA scores of 3-4, and treatment by proximal femoral plate were associated with shorter survival. The overall mean mHHS score was 53.80 ± 20.78.

CONCLUSION

We found several risk factors of mortality, including age ≥ 80 years, a > 48-hour delay to surgery, and pre-operative ASA scores of 3-4 in patients with proximal femoral fracture. Furthermore, the use of a proximal femoral plate was a significant risk factor for mortality and lower mHHS scores.

The incidence of musculoskeletal injuries: a systematic review and meta-analysis

Aims

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

Methods

PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model.

Results

The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures.

Conclusion

The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries. Cite this article: Bone Joint Res 2022;11(11):814–825.

Predicting Prolonged Hospital Stays in Elderly Patients With Hip Fractures Managed During the COVID-19 Pandemic in Chile: An Artificial Neural Networks Study

Background: Prolonged length of stay (LOS) after a hip fracture is associated with increased mortality. Purpose: We sought to create a model to predict prolonged LOS in elderly Chilean patients with hip fractures managed during the COVID-19 pandemic. Methods: Employing an official database, we created an artificial neural network (ANN), a computational model corresponding to a subset of machine learning, to predict prolonged LOS (≥14 days) among 2686 hip fracture patients managed in 43 Chilean public hospitals during 2020. We identified 18 clinically relevant variables as potential predictors; 80% of the sample was used to train the ANN and 20% was used to test it. The performance of the ANN was evaluated via measuring its discrimination power through the area under the curve of the receiver operating characteristic curve (AUC-ROC). Results: Of the 2686 patients, 820 (30.2%) had prolonged LOS. In the training sample (2,125 cases), the ANN correctly classified 1,532 cases (72.09%; AUC-ROC: 0.745). In the test sample (561 cases), the ANN correctly classified 401 cases (71.48%; AUC-ROC: 0.742). The most relevant variables to predict prolonged LOS were the patient’s admitting hospital (relative importance [RI]: 0.11), the patient’s geographical health service providing health care (RI: 0.11), and the patient’s surgery being conducted within 2 days of admission (RI: 0.10). Conclusions: Using national-level big data, we developed an ANN that predicted with fair accuracy prolonged LOS in elderly Chilean patients with hip fractures during the COVID-19 pandemic. The main predictors of a prolonged LOS were unrelated to the patient’s individual health and concerned administrative and organizational factors.

Impact of the COVID-19 Outbreak on Orthopedic Surgery: A Nationwide Analysis of the First Pandemic Year

Purpose

To analyze the impact of the coronavirus disease 2019 (COVID-19) outbreak during the first pandemic year in a single country.

Methods

A cross-sectional study was designed. The free access database of the Chilean Department of Statistics and Health Information (DEIS) was used to compare the number of orthopedic procedures between 2019 and 2020. Country mobility was exported from the Institute of Complex Engineering Systems (ISCI) free-access database; this corresponds to a direct measurement of the degree of confinement of the country. Spearman correlation (rho) was used to analyze the total monthly COVID infection trend and mobility to orthopedics procedures.

Results

The number of orthopedic surgeries fell by 22.8% during the first year of the pandemic. All surgical procedures were adversely affected, with the fracture/trauma surgeries being the least affected. The maximum adverse impact was seen in knee arthroplasty (-64%), followed by hip arthroplasty (-41%) and knee ligament reconstruction (-44%). The number of orthopedic procedures had a mild correlation to the monthly number of COVID-19 cases (rho=-0.53, p=0.08) and a strong correlation with the country's mobility (rho=0.94, p=0.0001).

Conclusions

The COVID-19 outbreak diminished the number of orthopedic procedures during 2020, and the impact was directly correlated to the country's mobility. The public health network did have a more significant adverse impact in elective surgeries due to a slower recovery than private institutions. An increase in the waiting list should be expected, which will widen the difference in access to orthopedic surgery in Chile.

Trends in Orthopedic Surgery in Chile: Analysis Between 2004 and 2020

Purpose To describe the trends of orthopedic surgery in Chile since 2004 in terms of the number and gender of surgeons, the incidence of procedures per 100,000 inhabitants (IR), and access by health insurance and type of health center. Methods A cross-sectional study was designed. Three databases were analyzed: the free access database of the Chilean Department of Statistics and Health Information (DEIS), which had information on all procedures performed in health institutions in Chile from 2004 to 2020. Then, the orthopedic surgeon registry was requested from the National Superintendence of Health (NSH). Finally, the database of the Chilean Society of Orthopaedic Surgeons (SCHOT) was analyzed. Spearman's correlation was used to determine significant trends during the analyzed period. Results The NSH reported 1770 orthopedic surgeons in 2020; 56% were affiliated with SCHOT. An upward trend in the proportion of female orthopedic surgeons was found, from 4.8% in 2004 to 7.6% in 2020. Since 2004, the IR of orthopaedic surgeries has been increasing significantly in both health insurances; the growth in public insurance follows a linear model (R2 = 0.970) of parameters β0 = - 55982.6 (p <0.000) and β1 = 28.02 (p <0.000) while in private insurance, the growth is also linear (R2 = 0.890) but with a greater slope: β0 = - 104136 (p <0.000) and β1 = 52.15 (p <0.000). A significant downward trend was found in the proportion of surgeries performed in the public health network (rho = -0.797, p = 0.0002). Conclusions There is a significant increase in the number of orthopedic surgeons and the number of procedures per 100,000 inhabitants. Nevertheless, there is evident inequity in access to orthopedic surgery in Chile and low gender diversity.

Hip fractures in the elderly Chilean population: a projection for 2030

Using national databases, we projected the magnitude of hip fractures among the elderly Chilean population by 2030. Hip fractures will increase by 27.5% from 2018 to 9862 cases (95% CI = 8760 to 10,965). The most substantial growth is expected to occur in patients older than 80 years of age.

INTRODUCTION

There is scarce information regarding the magnitude of hip fractures that will be observed in Latin American countries in the near future. The aim of this study is to project the volume of hip fractures in the elderly Chilean population by the year 2030.

METHODS

The database of the Chilean Department of Statistics and Health Information, which includes all hospital discharges within Chile, was employed to evaluate the volume of hip fractures observed from 2012 to 2018 in the elderly population (≥ 65 years old). The annual incidence was determined by combining the volume of fractures with census data. Linear regression analysis was performed to determine the projected volume of hip fractures for 2030.

RESULTS

For 2030, hip fractures among the elderly population are projected to grow 27.5% (R² = 0.92) to 9862 cases (95% CI = 8760 to 10,965). In the group from 65 to 79 years old, hip fractures are expected to grow 21.6% (R² = 0.87) to 3046 cases (95% CI = 2686 to 3405). In patients ≥ 80 years of age, hip fractures are expected to grow 30.1% (R² = 0.9) to 6817 cases (95% CI = 5889 to 7744).

CONCLUSIONS

A substantial growth in the volume of hip fractures is expected for the next decade among the elderly Chilean population, especially in patients ≥ 80 years of age. A national healthcare strategy should consider efforts to mitigate the impact of the future burden related to patients' care.