Multiple Comorbidities Portend Poor Postsurgical Course

June 3, 2007
Rebekah McCallister

Internal Medicine World Report, January 2006, Volume 0, Issue 0

Preoperative risk factors are a major concern when deciding whether or not to op?erate on elderly patients. New data suggest that mortality rates are high when an elderly person presents with a hip fracture and >=3 comorbidities (BMJ. 2005;331: 1374-1376).

The study included 2090 consecutive patients (mean age, 82 years; 80% women) who were admitted to a university teaching hospital with an acute hip fracture over a 4-year period. J. J. W. Roche, MD, clinical fellow, Department of Trauma and Orthopaedics, University Hospital Not?tingham, United Kingdom, and colleagues sought to determine the effects of both preoperative comorbidities and postoperative medical complications on mortality in the first month and first year after hip fracture surgery.

When the study began, 41% of the patients had no comorbidities (n = 1011), 35% had 1 comorbidity, 17% had 2 com?orbidities, and 7% had >=3 comorbidities.

Total mortality was 9.6% at 30 days (n = 231) and 33% at 1 year (n = 747). There was a significant gender difference in 30-day mortality, with 8.2% of the deaths occurring in women and 15% in men (P <0.01). The most commonly reported postoperative complications were chest infection (9%) and heart failure (5%). Of patients who developed heart failure after surgery, 65% died at 30 days, and 92% died by 1 year. Among patients who developed postoperative chest infection, 43% died at 30 days and 71% by 1 year.

The risks of death within the month after sur?gery were significantly in?crea?s?ed in patients with >=3 comorbidities, respiratory disease, and malignancy. Of note, smoking was not a major risk factor for postoperative postoperative chest infection and heart failure (P = .098).?

"Nine of 100 elderly patients with hip fracture in our series died within 1 month of the event," they wrote. "A fifth of patients had a postoperative compli?cation?.Further studies are re?quired to evaluate different systems of medial care to establish whether these can reduce ?incidence and severity of these complications."