The following is a summary of “Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: a nationwide inpatient sample analysis,” published in the November 2023 issue of Cardiology by Hassan et al.
Hip fractures often require hospitalization, especially in older adults who may also have aortic stenosis (AS). Researchers started a retrospective study to investigate postoperative outcomes, predictors of morbidity and mortality, and trends in patients with AS undergoing hip fracture surgery.
They performed a retrospective analysis using the Nationwide Inpatient Sample data (2008 to 2019). They identified hip fracture cases and isolated a subgroup with AS using specific ICD-9 and ICD-10 diagnostic codes. They then compared baseline features, in-hospital post-surgery results, and mortality/morbidity trends in AS and non-AS patients.
The results showed 2,834,919 patients identified with hip fractures in weighted analysis, 94,270 (3.3%) had concurrent AS. The AS group was older and had more cardiovascular comorbidities, such as heart disease, high blood pressure, and heart failure. Postoperative mortality was notably higher in the AS group compared to the non-AS group (3.3% vs 1.57%, P<0.001). Factors like congestive heart failure, age over 85 years, cardiac arrhythmias, end-stage renal disease, malnutrition, and AS were linked to higher adjusted postoperative mortality odds AS was connected to increased adjusted odds of postoperative mortality, and complications such as acute myocardial infarction, cardiogenic shock, and acute renal failure. Although the hospital stay duration was similar in both groups (average 5 days), the AS group incurred higher costs (mean $50,673 vs $44,607). The presence of acute heart failure in AS and hip fracture patients significantly elevated mortality, hospital stay, and costs. Postoperative in-hospital mortality decreased noticeably (2008 to 2019), while major in-hospital complications rose.
They concluded that AS significantly increases postoperative mortality and complication rates in hip fracture patients.