Factors determining the 1-year survival after operated hip fracture: a hospital-based analysis

Factors associated with 1-year survival of hip fracture in Chinese ethnicities has not been clearly elucidated. The purpose of this study was to determine the 1-year survival associated with operated hip fracture and its prognostic factors in a district teaching hospital from January 1, 1998 to 2006. Hip fracture admissions (ICD-9: 820) identified from an inpatient electronic database over a 9-year period were linked to Taiwan's national death registry. Actuarial analysis was used to determine the 1-year survival rates after hip fracture, which were further compared according to different concurrent illnesses. We used the Cox proportional hazard regression model to explore the significant determinants of 1-year survival of the study patients. The overall 1-year survival rate of all patients was 86%. This was lower if the operation was accompanied by certain co-morbidities, including heart failure [hazard ratio (HR) 6.12; 95% confidence interval (CI) 1.54-24.36], chronic obstructive pulmonary disease (HR 2.40; 95% CI 1.14-5.05), and pneumonia (HR 4.26; 95% CI 1.95-9.31). In addition, elderly patients (> 84 years of age) (HR 7.34; 95% CI 2.49-21.58), arthroplasty (HR 3.69; 95% CI 1.10-12.43), operative delay > 48 h (HR 2.86; 95% CI 1.08-7.54), low preoperative hemoglobin level (< 11 g/dl) (HR 2.58; 95% CI 1.33-5.01), and high creatinine level (a parts per thousand yen2 mg/dl) (HR 2.52; 95% CI 1.07-5.95) were all significantly associated with increased mortality. The 1-year survival for patients in this study hospital, 86%, was comparable to or higher than that of previous studies. Improved survival rates among hip fracture patients may be achieved by early recognition and prompt treatment of associated medical illnesses.