Complications and institutionalization are almost doubled after second hip fracture surgery in the elderly patient

Abstract

Purpose
To determine patient and hip fracture characteristics, early postoperative complication rate and need for institutionalization at time of discharge from the hospital in patients treated for a second, contralateral hip fracture.

Methods
During a six-year period (2003-2009) seventy-one patients (60 women and 11 men; age range 54 – 94 years) underwent first hip fracture surgery and subsequent contralateral hip fracture surgery at our hospital. Variables including age, gender, American Society of Anesthesiologists Classification (ASA), AO fracture classification, time between both hip fractures, rate and severity of early postoperative complications and destination of discharge were obtained from the electronic medical records. Data from both hospitalization periods were compared.

Results
Forty-six percent of second hip fractures occurred within two years after the first hip fracture. Following first hip fracture surgery 13 patients had one or multiple complications compared to 23 patients after second hip fracture surgery (P= 0.02). The mean time (± SD) between first and second hip fracture in patients without complications after the second injury was 4.3 (± 4.2) years, compared to 2.6 (± 2.1) years in patients with complications after the second injury (P= 0.03). The mean ASA classification of patients without complications after second hip fracture surgery was 2.6 (± 0.6) versus 3.0 (± 0.6) in patients with complications (P= 0.04). After first hip fracture surgery 27 patients (38%) were discharged to an institutional care facility, whereas 72% of patients resided at an institutional care facility after a second hip fracture.

Conclusions
Early complication rate in patients sustaining a second, contralateral hip fracture was almost twice that documented after the first hip fracture. Following second hip fracture surgery, most patients resided in an institutional care facility.