Department of Orthopedic Surgery, Bispebjerg Hospital, KBH NV, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 KBH N, Copenhagen, Denmark.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1861-1870. doi: 10.1007/s00068-021-01791-0. Epub 2021 Sep 30.
Excess mortality among hip fracture patients is well documented. Less is known, however, about the causes of death in this group of patients, although existing literature suggests that bronchopneumonia and cardiovascular diseases constitute the leading causes of death. In this study, we investigated the causes of death in Danish hip fracture patients, who died within 30-days after sustaining a hip fracture, with a focus on differences in causes of death between men and women and between different age groups. Furthermore, the frequency of potentially preventable causes of death such as pneumonia, urinary tract infections and thromboembolic events was examined.
All Danish patients aged 18 or more suffering from a hip fracture in the period 2002-2012 were examined for inclusion into the study. Data were collected from the Danish National Patient registry. The last month of 2012 being December was left out since we were looking at 30-days mortality. Logistic regression analysis was used to test the association between 30-day mortality with each of the causes of death adjusted for age, sex and CCI in multivariable models with results presented as odds ratios (OR) with 95% confidence intervals.
During this period, 93,637 patients sustained a hip fracture. Of these, 9504 patients died within 30-days and were included in the study. For patients dead within 30-days after sustaining a hip fracture, the two leading medical causes of death were cardiovascular disease (21.1%) and pneumonia (10.5%) when looking at both genders. A frequent cause of death especially in the younger age group of women less than 50 years old were infections (other than pneumonia) (18.2%) especially urinary tract infections. Pulmonary embolism accounted for 3.9% of causes of deaths in hip fracture patients.
In this study, cardiovascular disease and pneumonia were overall the leading medical causes of death in patients dead within 30-days after sustaining a hip fracture. Apart from pneumonia, another potentially preventable infection in younger female hip fracture patients was urinary tract infections. Pulmonary embolism, another potentially preventable cause of death might be underreported in Danish death certificates.
髋部骨折患者的超额死亡率已有充分记录。然而，对于这组患者的死亡原因知之甚少，尽管现有文献表明，支气管肺炎和心血管疾病是导致死亡的主要原因。在这项研究中，我们调查了丹麦髋部骨折患者的死亡原因，这些患者在髋部骨折后 30 天内死亡，重点关注男性和女性以及不同年龄组之间死亡原因的差异。此外，还检查了肺炎、尿路感染和血栓栓塞等潜在可预防死因的发生频率。
研究纳入了 2002 年至 2012 年期间丹麦年龄在 18 岁及以上的所有髋部骨折患者。数据来自丹麦国家患者登记处。由于我们研究的是 30 天死亡率，因此 2012 年的最后一个月（12 月）被排除在外。逻辑回归分析用于测试 30 天死亡率与多变量模型中每种死因之间的关联，调整了年龄、性别和 CCI，结果表示为比值比（OR）和 95%置信区间。
在此期间，93637 名患者发生髋部骨折。其中，9504 名患者在髋部骨折后 30 天内死亡，并纳入研究。对于髋部骨折后 30 天内死亡的患者，无论性别如何，心血管疾病（21.1%）和肺炎（10.5%）是两个主要的医学死因。对于年龄较小的女性（50 岁以下），除肺炎以外的感染（18.2%）尤其是尿路感染是常见的死因。肺栓塞占髋部骨折患者死因的 3.9%。
在这项研究中，心血管疾病和肺炎是髋部骨折后 30 天内死亡的患者的主要医学死因。除肺炎外，年轻女性髋部骨折患者的另一种潜在可预防感染是尿路感染。肺栓塞，另一种潜在可预防的死因，在丹麦死亡证明中可能报告不足。
