Mortality, Morbidity and Mobility: Outcomes after hip fracture among patients admitted to CWM hospital, Fiji: A 2-year retrospective study

Researcher: Prasad MD
Researcher Affiliations:
College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
Department of Orthopedics, Colonial War Memorial Hospital, Suva, Fiji
Department of Orthopedics, Waikato District Health Board, Hamilton, New Zealand
Key Words: (Neck of Femur, Hip fracture, Mortality, Morbidity, Mobility)
Objectives
The study aimed to establish the mortality rate of patients who undergo NOF surgery in CWMH. It also sought to establish the loss of mobility after surgery. It aimed to document the comorbidity profile, as well as the fracture profile of the study population. The study then draws the cause effect relationship between multiple variables and their effect on mortality of NOF patients treated at CWMH.
Design
The study was of a retrospective case control design
Setting
CWM hospital, Suva, Fiji
Participants
The inclusion criteria were all adults admitted to CWMH with a fractured NOF and underwent surgical treatment.
Interventions
4
Routine surgical management of NOF patients
Main outcome measures
The study establishes the mortality rate of the study population. It also documents the levels of mobility loss at 1 year following NOF surgery. Comorbidity profile of the study group is also described. The study investigates the cause-effect relationship between multiple variables, including comorbidities and mortality, loss of mobility and mortality, LOS and mortality as well as time to surgery and mortality. The fracture profile of the study population was also established. The effect of LOS on postoperative complications as well as ASA score on mortality was investigated. The study also establishes the burden of disease of hip fractures
Results
Majority of the study population were female, in their 6th decade of life, had one or more comorbidity. Mortality rate at 1 month was 5.31% and 25.66% at 1 year. Factors predictive of mortality at 1 year were: Length of inpatient stay (RR 2.46; SD 10.15; 95% CI 2.72 to 15.62 p<0.05); Time to surgery >10 days (RR 2.12; SD 8.60; 95% CI 4.49 to 16.05; p<0.05); Pressure ulcers (RR 3.56; p<0.05). Patients having 3 or more comorbidities, ASA Scores of 2 or more and Loss of 2 or more levels of mobility were proven to be not statistically significant predictors of mortality. The cost of treating the NOF patients over the study period was approximately FJD$473,824.69.
Conclusions
Results from CWMH confirm that our mortality rates are on par with countries such as Australia and New Zealand. Identifying length of stay, time to surgery and pressure sores as key prognostic features of mortality is significant as they are all modifiable factors. There needs to be protocols made aiming towards early optimization of comorbid patients in order to achieve early surgery (ideally within 48 hours), and decreasing the length of stay in hospital. Development of a ortho-geriatric service is vital in both preoperative and postoperative management of NOF patien