Risk Factors for Re-fractures After Hip Surgery in Elderly at Phrapokklao Hospital: A Retrospective Case Control Study
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Abstract
BACKGROUND: Osteoporotic hip fracture is a major health concern among aging populations. Refracture following hip fracture surgery further increases mortality and healthcare burden. However, data on the incidence and risk factors for refracture among the Thai population remain limited.
OBJECTIVES: To investigate the incidence and factors associated with refracture after hip fracture surgery in older adults.
METHODS: This retrospective case control study was conducted at Phrapokklao Hospital, Chanthaburi, Thailand. Medical records and radiographs of patients aged ≥50 years who sustained low-energy hip fractures and underwent surgical treatment between 2017 and 2023 were retrospectively reviewed. Patients were categorized into refracture and non-refracture groups. Collected variables included age, sex, body mass index (BMI), comorbidities, serum albumin level, hemoglobin level, estimated glomerular filtration rate (eGFR), total lymphocyte count (TLC), and cortical thickness index (CTI). The factors associated with refracture were analyzed using multivariable logistic regression analysis.
RESULTS: A total of 854 patients were included, with a mean age of 77.3 +/- 9.6 years. The cumulative incidence of refracture was 20.1% (95% confidence interval [CI]: 17.5–22.8), comprising 172 patients in the refracture group and 682 patients in the non-refracture group. Compared with the non-refracture group, the refracture group had a significantly higher proportion of females (84.9% vs. 68.2%, p<0.001), lower serum albumin levels (3.5±0.6 vs. 3.72±0.5 g/dL, p<0.001), and lower CTI values (0.4±0.1 vs. 0.5±0.1, p<0.001). Multivariable logistic regression analysis demonstrated that female sex (adjusted OR 2.39; 95% CI 1.50–3.77; p<0.001), serum albumin<3.5 g/dL (adjusted OR 1.96; 95% CI 1.35–2.83; p<0.001), and CTI<0.40 (adjusted OR 2.08; 95% CI 1.38–3.12; p=0.001) were independent risk factors for refracture. The most common refracture sites were the contralateral hip (46.5%) and spine (36%).
CONCLUSIONS: The incidence of refracture after hip fracture surgery in older adults was high. Female sex, hypoalbuminemia, and cortical bone thinning were independent risk factors for refracture. Early assessment of nutritional status and cortical thickness index may help identify high-risk patients and support strategies for preventing refracture.
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