McDonald CL, Cohen BH, Medina Pérez G, Modest JM, Kuris EO, Born C. Pre-Operative Medications as a Predictor for Post-Operative Complications Following Geriatric Hip Fracture Surgery.
Geriatr Orthop Surg Rehabil 2022;
13:21514593221091062. [PMID:
35450299 PMCID:
PMC9016589 DOI:
10.1177/21514593221091062]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background
Fragility hip fractures are a common orthopedic injury seen in Emergency
Departments, with variable outcomes that can range from average to
devastating. Currently, few reliable metrics to predict which patients will
suffer post-operative complications exist. The aim of this study was to
determine if the number and type of pre-operative medications can help
predict post-operative complications.
Methods
A prospectively collected database of hip fracture patients was
retrospectively reviewed. Patients with isolated greater trochanteric
fractures, periprosthetic fractures, or re-fractures were excluded.
Pre-operative baseline characteristics as well as number and type of
post-operative complications were reviewed. Any complication within 6 months
of surgery and complications that could be directly attributable to the
surgical procedure within 2 years of surgery were examined. Major
complications (return to the operating room, deep infection, pulmonary,
cardiac, and hematologic) and minor medical complications were assessed. A
multivariate regression model was performed to identify independent risk
factors.
Results
Three-hundred ninety-one patients were included. A majority were aged 80–90
and female, and lived at home prior to presentation. Overall, 33.7% of
patients suffered a complication within a 2-year follow-up period. Mortality
rates were 5.4%, 10.0%, and 14.9% over 30 days, 1 year, and 2 years,
respectively. After assessing this relationship while controlling for age,
sex, injury type, pre-operative residence, ambulatory status, ASA score, and
CCI score, the relationship remained significant for both an increased
number of complications (P = .048) and a higher likelihood
of having a complication (P = .008). Cardiovascular
(P = .003), pulmonary (P = .001), gout
(P = .002), or diabetes (P = .042)
medications were associated with a higher likelihood for experiencing a
complication.
Conclusions
Our study suggests that there is a strong and linear relationship between the
number and type of pre-operative medications taken and risk of
post-operative complications. This exists for up to 8 medications, at which
point further increase does not contribute to an increased risk of
complication. This relationship exists even after controlling for
confounding variables and can be used by surgeons to better counsel patients
and families regarding their specific risk for suffering perioperative
complications.
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