Pre-operative Anemia and Hyponatremia Increase the Risk of Mortality in Elderly Hip Fractures

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, AIIMS, New Delhi, India

2 Department of Orthopedic Surgery, JPNA Trauma Centre, AIIMS, New Delhi, India

Abstract

Objectives: Pre-operative assessment is routinely performed for all hip fractures, and include a thorough 
clinical examination and multiple pre-operative tests. While abnormalities are often detected in many 
tests, they have varied effect on mortality. The purpose of the study was to assess the prevalence and 
impact of these abnormal tests and comorbidities.
Methods: This was a prospective study of 283 consecutive hip fracture patients aged above 50 years admitted in a 
major trauma hospital from February 2019 to December 2019. The prevalence of abnormalities in the following tests 
were assessed: chest x-ray, electrocardiogram, complete blood count, serum electrolytes, renal function test, 
prothrombin time/international normalized ratio, and serum bilirubin. Also, presence of comorbidities were recorded. 
Mortality within 90 days of admission was assessed.
Results: 91.5% (N= 259/283) of the patients had at least one abnormal investigation. The most common abnormal 
investigation was anemia (70.3%, N= 199/283), followed by deranged sodium (36.4%, N= 103/283). 17.7% (N= 
50/283) of the patients had at least one new comorbidity diagnosed after admission. The most common newly 
diagnosed comorbidity was hypertension (10.6%, N= 30/283). Anemia (p=0.044), deranged sodium (p=0.002), 
raised urea (p=0.018), raised creatinine (p=0.002), renal disease (p=0.015), neurological diseases (p=0.024), and 
charlson comorbidity index (p=0.004) were associated with increased mortality in multivariate analysis.
Conclusion: Pre-operative hemoglobin, sodium, urea, and creatinine were the most important tests influencing 
mortality, and derangements of these should therefore be carefully evaluated and managed. Hip fracture care 
pathways should focus on correction of these abnormalities.
 Level of evidence: II

Keywords

Main Subjects


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