Predictors of hip fracture mortality in Ghana: a single-center prospective study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Archives of Osteoporosis
Abstract
Summary To determine risk factors influencing mortality in patients with proximal femur fractures in a Ghanaian hospital over a
4-year period.
Methods Incidence of mortality was assessed among 76 participants with proximal femur fractures from January to December
2014 and followed up for 4 years. Outcomes of interest were mortality at 1 month, 6 months, 1 year, and 4 years. Hazard ratios
(HRs) were calculated using Cox proportional hazards regression, adjusting for mortality risk factors.
Results Among the 76 participants (mean age 75.8 years [SD = 12.02], 36 (47.4%) males), there were 21 death cases. The mean
time of injury to surgery was 16.4 (SD = 16.2) days. Hip fractures comprised of 38 (50%) intertrochanteric, 35 (46.05%)
transcervical, and 3 (3.95%) basicervical. Mortality at 1 month, 6 months, 1 year, and 4 years were 6.6%, 13.2%, 19.7%, and
27.6%, respectively. Multiple regression analysis showed a yearly increase in age that was associated with a 1.03-fold increase in
the risk of death (p = 0.17). Comparing males to females, there was a significant difference in mortality (HR = 5.24, p = 0.03).
Participants with basicervical hip fracture versus those with transcervical hip fracture were at higher risk of dying (HR = 28.88, p
= 0.01). Patients with abnormal/low creatinine as compared to those with normal creatinine were at higher risk of dying (HR =
5.64, p = 0.005). Also, participants with an American Society of Anesthesiologists (ASA) score of III or IV were 2.73 times more
likely to experience death than those with an ASA score of I or II (95% CI: 0.93–8.89, p = 0.08). Additionally, a higher risk of
death was associatedwith patients with chronic obstructive pulmonary disease (COPD) (HR = 53.45, p = 0.001) and osteoporosis
(HR = 8.75, p = 0.006).
Conclusion Being male, having basicervical hip fracture, abnormal/low creatinine, and a history of COPD and osteoporosis were
the main predictors of mortality in the study population. These findings could serve as a guide when managing patients with
proximal femur fractures to improve the outcome.
Description
Research Article
Keywords
Hip fracture, Risk factors, Mortality, Ghana