Original Article

Aortic Stenosis Associated with an Increase in Mortality in Surgical Hip Fracture Patients

Authors: Eslam A. Fouda, MD, Harold E. Chaves-Cardona, MD, J. Ross Renew, MD, Aaron C. Spaulding, PhD, Steven B. Porter, MD

Abstract

Objectives: The majority of hip fracture patients in the United States are older adult patients with multiple comorbidities. Aortic stenosis (AS) in older adult patients with traumatic hip fracture is not uncommon. This study investigated the association between AS and postoperative mortality and serious complications.

Methods: In this retrospective cohort study, a chart review was performed of patients with AS who underwent hip fracture surgical repair between January 2011 and December 2019 within one health system. A control group of hip fracture patients without AS was identified and matched based on body mass index, age, sex, date of surgery and Charlson Comorbidity Index. The primary outcome of interest was 90-day mortality; secondary outcomes included 30-day postoperative complications, intensive care unit admission (ICU), and hospital length of stay.

Results: In total, 146 hip fracture patients with AS and 146 without AS were identified. In the AS group, there was an increased odds of 90-day mortality (odds ratio 2.64, 95% confidence interval 1.32–5.28, P = 0.005), and an increased odds of ICU admission (odds ratio 3.00, 95% confidence interval 1.36–6.68, P = 0.004).

Conclusions: The presence of AS was independently associated with an increase in 90-day mortality and postoperative ICU stay in patients undergoing surgical repair of a hip fracture.
Posted in: Rheumatology and Orthopedics26

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007;22:465–475.
 
2. Gallagher JC, Melton LJ, Riggs BL, et al. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res 1980: 163–171.
 
3. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP). https://hcupnet.ahrq.gov/. Accessed December 20, 2021.
 
4. Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States. JAMA 2009;302:1573–1579.
 
5. Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 2018;8:13933.
 
6. van de Ree CLP, De Jongh MAC, Peeters CMM, et al. Hip fractures in elderly people: surgery or no surgery? A systematic review and metaanalysis. Geriatr Orthop Surg Rehabil 2017;8:173–180.
 
7. Eveborn GW, Schirmer H, Heggelund G, et al. The evolving epidemiology of valvular aortic stenosis. The Tromsø study. Heart 2013;99:396–400.
 
8. Lindroos M, Kupari M, Heikkilä J, et al. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 1993;21:1220–1225.
 
9. Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003;51:364–370.
 
10. Kwok CS, Bagur R, Rashid M, et al. Aortic stenosis and non-cardiac surgery: a systematic review and meta-analysis. Int J Cardiol 2017;240:145–153.
 
11. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e35–e71.
 
12. Rostagno C, Ranalli C, Polidori G, et al. Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy. Trauma Surg Acute Care Open 2019;4:e000218.
 
13. Leibowitz D, Rivkin G, Schiffman J, et al. Effect of severe aortic stenosis on the outcome in elderly patients undergoing repair of hip fracture. Gerontology 2009; 55:303–306.
 
14. Adunsky A, Kaplan A, Arad M, et al. Aortic stenosis in elderly hip fractured patients. Arch Gerontol Geriatr 2008;46:401–408.
 
15. Keswani A, Lovy A, Khalid M, et al. The effect of aortic stenosis on elderly hip fracture outcomes: a case control study. Injury 2016;47:413–418.
 
16. Tashiro T, Pislaru SV, Blustin JM, et al. Perioperative risk of major non-cardiac surgery in patients with severe aortic stenosis: a reappraisal in contemporary practice. Eur Heart J 2014;35:2372–2381.
 
17. Agarwal S, Rajamanickam A, Bajaj NS, et al. Impact of aortic stenosis on postoperative outcomes after noncardiac surgeries. Circ Cardiovasc Qual Outcomes 2013;6:193–200.
 
18. Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture—a systematic review. World J Orthop 2019;10:166–175.