Analysis of hospital mortality in patients with proximal femoral fractures

V.O. Babalyan


Background. Proximal femoral fracture is the cause of a significant number of social consequences. First of all, this is due to the high risk of mortality in these injuries. The greatest risk of death after a hip fracture occurs in the first 3–6 months and ranges from 12 to 24 %. The purpose was to analyze the mortality of patients with proximal femoral fractures during the period of stay in a hospital. Materials and methods. A retrospective analysis of the history of the disease of the females with proximal femoral fractures, who were hospitalized in the department of traumatology for adults of the Kharkiv Municipal Clinical Multidisciplinary Hospital No. 17 from 2011 to 9 months of 2018, was conducted. We evaluated the age of the patient, duration of hospitalization from the moment of injury, period from the trauma to the beginning of surgical intervention, period from injury to death, type of treatment, concomitant diagnosis, cognitive status according to neuropathologists or psychiatrists, the degree of surgical risk by assessing the physical status of the patient, pathoanatomical diagnosis based on the results of forensic medical examination, divergence of clinical diagnosis and pathologoanatomical diagnosis. Results. Eighteen records of patients who died in a hospital were analyzed, of which 8 patients had X-ray signs of acetabular fracture and 10 (55 %) — medial femoral neck fracture. The average age was 77 years. Surgeries were performed in 9 (50 %) patients. On the first day, 2 (11 %) persons died, during the first week — 3 (16 %), from the first to the third week — 8 (44 %), and in the longer period, from 21 to 103 days, — 5 (27 %) patients. The assessment of cognitive status was performed in 13 (72 %) individuals. Patients’ comorbid status was determined: in 100 % of cases, ischemic heart disease, hypertension, heart failure, coronary sclerosis were detected, in 7 cases (38 %) — diabetes mellitus type 2, and in 2 cases — malignant neoplasms. The main cause of lethality was acute heart failure. In three died patients, pneumonia was diagnosed postmortem, it was not detected clinically. During the period of observation, 12,227 patients were hospitalized in the traumatology clinic, of them the proximal femoral fractures were detected in 561 cases. The hospital mortality rate for the defined group was 0.15 %. Attention is drawn to the late diagnosis of inflammation of the pulmonary tissue, which is explained by the poor quality of chest X-ray in prone position or mobile X-ray apparatus. In all died persons, a significant comorbid state was determined, which is a predictor of the complicated course of postoperative or post-traumatic period. Conclusions. The most common cause of hospital mortality in patients with proximal femoral fractures is acute circulatory failure. The combination of cognitive impairment with comorbidity in the somatic status of the patients is a significant predictor of a high degree of surgical risk.


hospital mortality; proximal femoral proximal femoral fractures


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