PH worsens patient outcomes after hip fracture surgery: Study
Disease tied to post-surgical mortality, in-hospital complications, re-admissions
People with pulmonary hypertension (PH) see worse outcomes following surgery to correct a hip fracture, a study shows.
Among hip fracture patients, PH was associated with higher rates of post-surgical mortality, major in-hospital complications, and hospital re-admissions within three months. Those with severe PH had the worst outcomes after surgery.
“Patients and patient family members should be counseled on the outcomes of hip fractures with [a] diagnosis of pulmonary hypertension,” the researchers wrote. “Providers must recognize these at-risk patients at the time of arrival to adjust care planning accordingly.”
The study, “Under pressure: symptomatic pulmonary hypertension is a predictor of poor outcome following hip fracture,” was published in the European Journal of Orthopaedic Surgery & Traumatology.
PH is a chronic and progressive disease marked by high blood pressure in the pulmonary arteries, the blood vessels that pass through the lungs. Elevated blood pressure in these arteries means the right side of the heart works harder to pump blood, which can lead to heart failure. In some surgeries, having PH can increase the risk of further illness and mortality.
Heart failure, diabetes, and chronic pulmonary disease are among the most common coexisting disorders in people with hip fractures, which also occur more in older people, a population with a higher risk of PH.
“However, there is little literature investigating the impact of pulmonary hypertension in the orthopedic trauma population, specifically geriatric hip fractures,” the researchers wrote.
Effect of PH on hip fracture surgery
Here, researchers at the NYU Langone Orthopedic Hospital in New York looked at the impact of PH on outcomes related to surgery to correct hip fractures in geriatric patients.
Of 1,709 hip fractures reviewed, 67 patients (3.9%) had PH. These patients were matched with 201 hip fracture cases without PH based on various factors, including age, sex, coexisting medical conditions, and mobility. The mean age of all the patients was 82.2, and most were women (68.3%) and white (72.8%).
Patients with PH saw a significantly higher rate of mortality than non-PH patients after hip fracture surgery while in the hospital (5.97% vs. 1.49%), after 30 days (16.42% vs. 4.48%), and after a year (22.39% vs. 11.94%). Major complications (22.39% vs. 8.46%) and re-admission at 90 days occurred significantly more often in the PH group (26.87% vs. 13.93%). Also, a significantly higher proportion of PH patients died within 30 days of surgery than those without PH (73% vs. 38%).
PH was independently associated with a higher 30-day mortality rate by 3.5 times, one-year mortality by 2.7 times, major inpatient complications by 2.5 times, and 90-day re-admissions by 1.2 times, an adjusted statistical analysis found.
Patients with severe PH had a significantly higher rate of major complications than those with moderate PH (50% vs. 13.64%) and mild PH (50% vs. 11.11%). Severe PH patients also had longer hospital stays on average and were admitted to the intensive care unit more often.
Consistently, those with mild PH had a significantly better health-related quality of life than those with moderate and severe PH, as assessed by the validated EuroQol 5-Dimension 5-level questionnaire.
“Patients who carry a diagnosis of pulmonary hypertension who sustain a hip fracture experienced significantly worse inpatient and post-discharge outcomes,” the researchers wrote. “Those with a [severe PH] had worse outcomes.”
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