Comparison of complications and mortality in patients with closed osteoporotic intertrochanteric fracture who underwent internal fixation within and after 48 hours in Sunpasitthiprasong Hospital

Abstract

Background: Osteoporotic intertrochanteric fracture leads to significant morbidity and mortality and increasing evidence suggests that early surgery could improve these outcomes. However, evidence in developing countries is limited. The present study aimed to described mortality and postoperative complications as well as their association with time to surgery in patients with closed osteoporotic intertrochanteric fractures who underwent internal fixation in a tertiary hospital.
Methods: In this prospective cohort study, sociodemographic and clinical data of 209 closed osteoporotic intertrochanteric fracture patients treated at Sunpasitthiprasong hospital were collected. Mortality, mortality rate and occurrence of complications were computed. Survival time was defined as suration between date of surgery to date of death, or 12 months for those who survived. Kaplan-Meier curves were plotted and survival was compared using the log rank test. Factors associated with risk of mortality and morbidity were analyzed using Cox proportional hazard regression and logistic regression.
Results: The average (SD) age of patients was 76.6 (10.9) years, with 65% being females. Among 209 patients, 40 died, a 1-year mortality of 19.1%, with lower mortality in those with early than delayed internal fixation (9.4% and 25.8% respectively). Over 1 year of follow-up, 61 patients (29.2%) developed at least one complication. Patients receiving internal fixation after 48 hours had a 2.3-fold higher risk of mortality and an almost 4-fold higher risk of postoperative complications than those receiving internal fixation within 48 hours (Adjusted hazard Ratio 2.29 (95% CI 1.03-5.10)) and Adjusted odds ratio 3.75 (95% CI 1.83-7.66) respectively)). These associations were not altered after controlling for age, sex, comorbidities, ASA category, Evans classification and type of implants.
Conclusions: Delayed surgery was associated with an increased risk of mortality and postoperative complications in patients with closed osteoporotic intertrochanteric fracture undertaking internal fixation. This underlines the importance of a fast-track program for surgical treatment in this groups of patients.