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Preoperative status and risk of complications in patients with hip fracture

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Abstract

BACKGROUND: Limited information is available on preoperative status and risks for complications for older patients having surgery for hip fracture. Our objective was to identify potentially modifiable clinical findings that should be considered in decisions about the timing of surgery.

METHODS: We conducted a prospective cohort study with data obtained from medical records and through structured interviews with patients. A total of 571 adults with hip fracture who were admitted to 4 metropolitan hospitals were included.

RESULTS: Multiple logistic regression was used to identify risk factors (including 11 categories of physical and laboratory findings, classified as mild and severe abnormalities) for in-hospital complications. The presence of more than 1 (odds ratiol [OR] 9.7, 95% confidence interval [CI] 2.8 to 33.0) major abnormality before surgery or the presence of major abnormalities on admission that were not corrected prior to surgery (OR 2.8, 95% CI 1.2 to 6.4) was independently associated with the development of postoperative complications. We also found that minor abnormalities, while warranting correction, did not increase risk (OR 0.70, 95% CI 0.28 to 1.73).

CONCLUSIONS: In this study of older adults undergoing urgent surgery, potentially reversible abnormalities in laboratory and physical examination occurred frequently and significantly increased the risk of postoperative complications. Major clinical abnormalities should be corrected prior to surgery, but patients with minor abnormalities may proceed to surgery with attention to these medical problems perioperatively.

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Authors and Affiliations

  1. Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, 10029, New York, NY

    Mary Ann McLaughlin MD, MPH, Thomas McGinn MD, R. Sean Morrison MD, Tsivia Hochman MS, Marvin Gilbert MD & Albert L. Siu MD, MSPH

  2. Bronx Veterans Affairs Medical Center, Bronx, NY, USA

    Mary Ann McLaughlin MD, MPH, R. Sean Morrison MD, Tsivia Hochman MS & Albert L. Siu MD, MSPH

  3. University of Arkansas for Medical Science, Fort Smith, AR, USA

    Gretchen M. Orosz MD

  4. School of Medicine, University of Maryland, Baltimore, MD, USA

    Jay Magaziner PhD

  5. State University of New York, University at Albany School of Public Health, Albany, NY, USA

    Edward L. Hannan PhD

  6. Hospital for Joint Diseases, New York, NY, USA

    Kenneth Koval MD

Authors
  1. Mary Ann McLaughlin MD, MPH
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  2. Gretchen M. Orosz MD
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  3. Jay Magaziner PhD
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  4. Edward L. Hannan PhD
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  5. Thomas McGinn MD
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  6. R. Sean Morrison MD
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  7. Tsivia Hochman MS
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  8. Kenneth Koval MD
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  9. Marvin Gilbert MD
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  10. Albert L. Siu MD, MSPH
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Corresponding author

Correspondence to Mary Ann McLaughlin MD, MPH.

Additional information

The authors have no conflicts of interest to declare for this article.

This project was supported in part by grants from the Agency for Healthcare Research and Quality (U18HS09459-0), The Mary and David Hoar Program of the New York Academy of Medicine (McLaughlin), the National Institute on Aging (Midcareer Investigator Award to Dr. Siu and Mentored Clinical Scientist Development Award to Dr. Morrison), and the American Federation for Aging Research Paul Beeson Faculty Scholar Award (Dr. Morrison).

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McLaughlin, M.A., Orosz, G.M., Magaziner, J. et al. Preoperative status and risk of complications in patients with hip fracture. J Gen Intern Med 21, 219–225 (2006). https://doi.org/10.1111/j.1525-1497.2006.00318.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00318.x

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