Introduction One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age. Objective The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures. Method This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000-2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF. Results The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63-1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82-0.89) versus 0.68 (95% CI 0.61-0.74), p Conclusions Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.

Atrial Fibrillation and Mortality in the Oldest Old after Surgery for Hip Fractures.

The purpose of this study was to analyze the potential risk factors for mortality 1 year after hip fracture surgery in critically ill older adults.We reviewed 591 critically ill older adults who underwent hip surgery at our institution from January 2018 to April 2021. We collected baseline demographics, clinical information, and 1-year survival status of the sample patients by means of medical record systems and follow-up phone calls. Patients were divided into survival and mortality groups based on survival within 1 year after surgery.Based on the results of the 1-year postoperative follow-up of patients, we obtained 117 cases in the death group and 474 cases in the survival group, and this led to a 1-year mortality rate of 19.8% (117/591) after hip fracture in critically ill older adults at our hospital. The risk factors that influenced the 1-year postoperative mortality were identified as advanced age (HR:1.04, 95%, 1.01-1.06), preoperative arrhythmia (HR: 1.95, 95%, 1.26-2.70), high level of NLR (HR:1.03, 95%, 1.01-1.06), respiratory failure (HR: 2.63, 95%, 1.32-5.23), and acute cardiovascular failure. 5.23) and acute cardiovascular events (HR: 1.65, 95%, 1.05-2.59).Advanced age, preoperative arrhythmias, high levels of NLR, postoperative respiratory failure, and acute cardiovascular events were independent risk factors for survival of critically ill older adults with hip fracture at 1 year after surgery. Therefore, laboratory tests such as high levels of preoperative NLR can be an important indicator of patient prognosis. 

Identification of risk factors for 1-year mortality among critically ill older adults with hip fractures surgery: A single medical center retrospective study

The serum NT-proBNP is associated with all-cause mortality in geriatric hip fracture: a cohort of 1354 patients

OBJECTIVE: To evaluate the association between preoperative cholinesterase levels and all-cause mortality in geriatric hip fractures.METHODS: Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative cholinesterase levels and mortality in these patients. Analyses were performed using EmpowerStats and the R software.RESULTS: Two thousand three hundred eighty-seven patients were included in this study. The mean follow-up period was 37.64 months. Seven hundred eighty-seven (33.0%) patients died due to all-cause mortality. Preoperative cholinesterase levels were 5.91±1.70 (×1000 U/L). Linear multivariate Cox regression models showed that preoperative cholinesterase level was associated with mortality (HR=0.83, 95% CI:0.78-0.88), P<0.0001) after adjusting for confounding factors. However, the linear association was unstable, and nonlinearity was identified. A cholinesterase concentration of 5.94 (×1000 U/L) was an inflection point for prediction. A preoperative cholinesterase level < 5.94 (×1000 U/L) was associated with mortality (HR=0.72, 95%CI: 0.66-0.79, P<0.0001), whereas that > 5.94 (×1000 U/L) was not a risk factor for mortality (HR=1.01, 95%CI: 0.91-1.11, P=0.9157). We found that the nonlinear association was very stable in the propensity score-matching sensitive analysis.CONCLUSIONS: Preoperative cholinesterase levels were nonlinearly associated with mortality in elderly hip fractures, and cholinesterase was a risk indicator of all-cause mortality. However, cholinesterase level was not associated with mortality when cholinesterase > 5.94 (×1000 U/L).Registration: ChiCTR2200057323(08/03/2022) 

The Effect of Preoperative Serum Cholinesterase on All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study

Abstract AIM: The aim of this study is to examine potential risk factors for 1-year mortality after hip fracture surgery. METHODS: We reviewed 591 elderly and critically ill patients who underwent hip surgery at our institution from January 2018 to April 2021 retrospectively. The baseline demographic, clinical data and 1-year survival status in both groups were collected through the medical record system and follow-up phone calls. Patients were divided into survival group and death group according to the survival status within the first postoperative year. RESULTS: According to the results from 1year follow-up, 117 cases were classified into the death group while 474 cases were in the survival group, and it was calculated that the 1-year mortality rate of elderly and critically ill patients with hip fracture was 19.8% (117/591) in our hospital. The identified risk factors for 1-year mortality were advanced age (HR:1.04, 95%:1.01- 1.06), preoperative arrhythmia (HR: 1.95, 95%: 1.26 - 2.70), high level of NLR (HR:1.03, 95%:1.01 - 1.06), respiratory failure (HR: 2.63, 95%:1.32 - 5.23) and acute cardiovascular events (HR: 1.65, 95%:1.05 - 2.59). CONCLUSION: Advanced age, preoperative comorbid arrhythmias, preoperative high level of NLR, respiratory failure and acute cardiovascular events postoperatively were independently associated with increased risk of 1-year mortality rate of critically ill elderly patients with hip fracture. Laboratory tests such as high level of NLR preoperative can be used as important indicators to determine the prognosis of patients. 

Identification of risk factors for 1-year mortality among elderly and critically ill patients with hip fractures surgery: A single medical center retrospective study

BACKGROUND Atrial fibrillation (AF) and hip fractures are both prevalent in the elderly population. The aim of this study was to systematically review the literature regarding the association between AF and hip fractures, and the impact of AF on hip fracture prognosis. METHODS The literature search was performed using PubMed, MEDLINE, Embase and Scopus. Inclusion was based upon the application of eligibility criteria in duplicate prior to data extraction with a standardized form. RESULTS A total of 42 studies met the inclusion criteria. AF prevalence was found to vary between 6.5% and 35% in cohorts. Large studies with broad inclusion criteria found the prevalence of AF in hip fracture patients to be approximately 12-15%. There were conflicting results as to whether patients with AF have an increased rate of hip fractures, as compared to patients without AF. Several studies demonstrated that hip fracture patients with AF have increased rates of mortality, both as an inpatient and following discharge, and increased readmission rates. CONCLUSION AF and hip fractures frequently coexist, and there is evidence to suggest AF is associated with increased readmission and mortality rates in hip fracture patients. Elements of the relationship between AF and hip fractures remain uncertain and further prospective studies on AF and hip fracture cohorts may clarify this relationship. Interventional studies targeting hip fracture patients with AF may be beneficial.

Association between atrial fibrillation and hip fractures and the implications for hip fracture patients: a systematic review

Use of alpha-adrenergic antagonists for lower urinary tract symptoms is not associated with worsening cognitive function.

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Association between atrial fibrillation and hip fractures and the implications for hip fracture patients: a systematic review

Use of alpha-adrenergic antagonists for lower urinary tract symptoms is not associated with worsening cognitive function.