Understanding One-year Mortality Rates and Comorbidity Burden in Older Adults Following Hip Fracture.

Abstract

Hip fractures impose substantial patient morbidity and burden to health care systems globally, with potentially high and variable 1-year mortality rates. To improve shared decision making when guiding treatment for patients, this study evaluated 1-year mortality rates following hip fractures in the older adult population using a large multicenter live database. The study goal was to determine the recent 1-year mortality rate with contemporary orthogeriatric care strategies. A retrospective cohort study was conducted using the TriNetX Research Network. Patients aged 65 to 90 years with an incident hip fracture were identified, excluding those with same-day mortality or previous hip fractures. Cohorts were stratified by sex and 5-year age intervals. One-year all-cause mortality rates following hip fracture and Kaplan-Meier survival (KM) estimates, with log-rank tests, were calculated. Pre-fracture demographic and clinical characteristics were compared between those who succumbed within 1 year and those who survived beyond 1 year. Among 197,222 included patients, the 1-year mortality rate was 11.6%, with an 86.7% KM estimate of survival. One-year mortality increased with age and was higher in men across all age strata. Patients with 1-year mortality demonstrated a higher baseline comorbidity burden, including neurocognitive, cardiovascular, metabolic, renal, hepatic, and pulmonary diseases and malignancies. Although women succumbing within 1 year had higher rates of certain neurocognitive and metabolic disorders, men had higher rates of chronic ischemic heart disease and chronic kidney disease. One-year mortality following hip fractures was approximately 12%. Continued monitoring and optimization of multidisciplinary orthogeriatric models and postoperative care may further improve outcomes and survival.