The effect of aortic stenosis on elderly hip fracture outcomes: A case control study

Aakash Keswani; Andrew Lovy; Mian Khalid; Ira Blaufarb; Calin Moucha; David Forsh; Darwin Chen

doi:10.1016/j.injury.2015.10.015

The effect of aortic stenosis on elderly hip fracture outcomes: A case control study

Injury. 2016 Feb;47(2):413-8. doi: 10.1016/j.injury.2015.10.015. Epub 2015 Oct 28.

Authors

Aakash Keswani¹, Andrew Lovy², Mian Khalid², Ira Blaufarb², Calin Moucha², David Forsh², Darwin Chen²

Affiliations

¹ Icahn School of Medicine at Mount Sinai, E 98th St., NY 10029, USA; Mount Sinai Hospital, Department of Orthopaedic Surgery, 5 E 98th St., NY 10029, USA. Electronic address: aakash.keswani@icahn.mssm.edu.
² Icahn School of Medicine at Mount Sinai, E 98th St., NY 10029, USA; Mount Sinai Hospital, Department of Orthopaedic Surgery, 5 E 98th St., NY 10029, USA.

PMID: 26556487
DOI: 10.1016/j.injury.2015.10.015

Abstract

Introduction: Aortic stenosis (AS) is an established predictor of perioperative complications following both cardiac and non-cardiac surgery. The purpose of this study was to evaluate the risk of mortality and perioperative complications among surgically treated hip fractures in elderly patients with moderate or severe AS compared to those without AS (negative controls).

Materials and methods: A retrospective case-controlled review (1:2) of elderly (≥65 years) surgically treated hip fractures from 2011 to 2015 with moderate/severe AS (according to American Heart Association criteria) was conducted. Postoperative complication rates, 30 days and 1 year mortality were reviewed.

Results: Moderate/severe AS was identified in 65 hip fracture cases and compared to 129 negative controls. AS cases were significantly older with higher rates of coronary artery disease and atrial fibrillation (p<0.05). Rates of any 30-day perioperative complication (74% vs. 37%, p<0.001) and severe non-cardiac 30-day perioperative complication (52% vs. 26%, p=0.002) were significantly higher among AS cases compared to controls. Kaplan Meier estimates of 30-day mortality (14.7% vs. 4.2%, p<0.001) and 1-year mortality (46.8% vs. 14.1%, p<0.001) were significantly higher in AS cases compared to controls. Multivariate analysis of severe 30-day postoperative complications identified moderate/severe AS (OR 4.02, p=0.001), pulmonary disease (OR 7.36, p=0.002) and renal disease (OR 3.27, p=0.04) as independent predictors. Moderate/severe AS (OR 3.38, p=0.03), atrial fibrillation (OR 3.73, p=0.03) and renal disease (OR 4.44, p=0.02) were independent predictors of 30-day mortality. Moderate/severe AS (OR 5.79, p<0.001) and renal disease (OR 3.39, p=0.02) were independent predictors of 1-year mortality.

Conclusion: Aortic stenosis is associated with a significantly increased risk of perioperative complications, 30-day mortality and 1-year mortality in elderly patients undergoing surgical treatment of hip fractures.

Keywords: Adverse event; Aortic stenosis; Elderly; Hip fracture; Mortality; Perioperative risk.

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Stenosis / complications
Aortic Valve Stenosis / mortality*
Aortic Valve Stenosis / physiopathology
Case-Control Studies
Echocardiography
Female
Hip Fractures / mortality*
Hip Fractures / physiopathology
Hip Fractures / surgery
Humans
Incidence
Male
Perioperative Care / methods*
Postoperative Complications / mortality*
Postoperative Complications / prevention & control
Postoperative Period
Retrospective Studies
Risk Assessment
Risk Factors
Treatment Outcome
United States / epidemiology