Skip Navigation



BJA Advance Access published online on October 29, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei010
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
94/1/24    most recent
aei010v1
Right arrow E-Letters: Submit a response to the article
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Foss, N. B.
Right arrow Articles by Kehlet, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Foss, N. B.
Right arrow Articles by Kehlet, H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Accepted September 8, 2004

Clinical Investigation

Mortality analysis in hip fracture patients: implications for design of future outcome trials

N. B. Foss 1* and H. Kehlet 2

1 Department of Anaesthesia, Hvidovre University Hospital, Copenhagen DK-2650, Denmark; Department of Orthopaedic Surgery, Hvidovre University Hospital, Copenhagen DK-2650, Denmark
2 Department of Surgical Gastroenterology, Hvidovre University Hospital, Copenhagen DK-2650, Denmark

* To whom correspondence should be addressed.
N. B. Foss, E-mail: nicolai.bang.foss{at}hh.hosp.dk


  Abstract

Introduction. Patients with hip fractures are usually frail and elderly with a 30-day mortality in excess of 10% in European series. Perioperative morbidity is often multifactorial in nature, and unimodal interventions will not necessarily decrease mortality. The purpose of this prospective study was to analyse causes of mortality, and thereby the potential and limitations to decrease mortality after hip fracture surgery.

Methods. 300 consecutive, unselected hip fracture patients were treated in a multimodal rehabilitation programme with continuous perioperative epidural analgesia and anaesthesia, early surgery, standardized fluid and transfusion therapy, enforced oral nutrition and early mobilization and physiotherapy. All deaths within 30 days of surgery or during primary hospitalization were analysed and classified according to whether death was unavoidable, probably unavoidable, or potentially avoidable.

Results. Thirty-day mortality was 13.3% (40 patients) and the total perioperative mortality was 15.6% (47 patients). Death was definitely unavoidable in 28%, probably unavoidable in 15%, and in theory potentially avoidable in 57%. In the patients where death was potentially avoidable, active care was curtailed in 16 of 27 (59%) patients.

Conclusion. About a quarter of the total mortality in hip fracture patients is definitely unavoidable, and death is probably only avoidable in about half of the unselected patients. These results have important implications for the design of future outcome studies, which should focus on other relevant outcomes than mortality per se.

Keywords: anaesthesia, audit; anaesthetic techniques, epidural; analgesia, techniques, extradural; complications; surgery, orthopaedic.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Age AgeingHome page
S. Ausset, V. Minville, C. Marquis, O. Fourcade, N. Rosencher, D. Benhamou, and Y. Auroy
Postoperative myocardial damages after hip fracture repair are frequent and associated with a poor cardiac outcome: a three-hospital study
Age Ageing, July 1, 2009; 38(4): 473 - 476.
[Full Text] [PDF]

Home page
 Age AgeingHome page
N. B. Foss, P. S. Jensen, and H. Kehlet
Risk factors for insufficient perioperative oral nutrition after hip fracture surgery within a multi-modal rehabilitation programme
Age Ageing, September 1, 2007; 36(5): 538 - 543.
[Abstract] [Full Text] [PDF]

Home page
 ptjournalHome page
M. T Kristensen, N. B Foss, and H. Kehlet
Timed "Up & Go" Test as a Predictor of Falls Within 6 Months After Hip Fracture Surgery
Physical Therapy, January 1, 2007; 87(1): 24 - 30.
[Abstract] [Full Text] [PDF]

Home page
 Clin RehabilHome page
N. B Foss, M. T Kristensen, and H. Kehlet
Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score
Clinical Rehabilitation, August 1, 2006; 20(8): 701 - 708.
[Abstract] [PDF]

Home page
 J Bone Joint Surg BrHome page
N. B. Foss and H. Kehlet
Hidden blood loss after surgery for hip fracture
J Bone Joint Surg Br, August 1, 2006; 88-B(8): 1053 - 1059.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
N. B. Foss and H. Kehlet
Short-term mortality in hip fracture patients admitted during weekends and holidays
Br. J. Anaesth., April 1, 2006; 96(4): 450 - 454.
[Abstract] [Full Text] [PDF]

Home page
 Qual Saf Health CareHome page
R Sund and A Liski
Quality effects of operative delay on mortality in hip fracture treatment
Qual. Saf. Health Care, October 1, 2005; 14(5): 371 - 377.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.