Trends in Comorbidities and Complications Among Patients Undergoing Hip Fracture Repair

Janis Bekeris, MD; Lauren A. Wilson, MPH; Dace Bekere, MD; Jiabin Liu, MD, PhD; Jashvant Poeran, MD, PhD; Nicole Zubizarreta, MPH; Megan Fiasconaro, MS; Stavros G. Memtsoudis, MD, PhD, MBA


Anesth Analg. 2021;132(2):475-484. 

In This Article


Between 2006 and 2016, we identified a total of N = 507,274 hip fracture repair cases.

While statistically significant, most trends in patient and health care characteristics demonstrated clinically insignificant changes throughout the study period (Table 1). The most pronounced trends were seen for anesthesia type, hospital size, and surgical approach. While starting from a low baseline, there was a significant decline between 2006 and 2016 in the use of neuraxial anesthesia: 7.3% to 3.6% and 6.3% to 3.4% (P < .0001) for neuraxial anesthesia and neuraxial/general anesthesia combined, respectively. An increasing proportion of cases were performed in small (<300 beds) hospitals (31.9% vs 41.3%), while this proportion decreased in medium-sized (300–500 beds) hospitals (38.0% to 30.4%; P < .0001; Figure 1). Throughout the observed time period, most patients were diagnosed with femoral neck fracture (50.8% in 2016), followed by intertrochanteric fracture for which a small but significant proportional increase was seen (34.2% vs 37.7%; P < .0001). The incidence of multifractured femur decreased from 10.8% to 7.4% over the study time frame (P < .0001). The most commonly performed hip fracture repair surgery was internal fixation representing almost two-thirds of all cases throughout the study period. At the same time, hemiarthroplasty remained the second most frequent procedure declining from 34.7% to 32.3% over time (P < .0001). Notably, the use of THA doubled (3.4% vs 7.1%; P < .0001) in the same time frame.

Figure 1.

Trends in hospital size among hip fracture patients between 2006 and 2016.

The prevalence of many preexisting comorbid conditions increased over time (Table 2). Indeed, the proportion of patients with >3 comorbidities significantly increased from 33.9% to 43.4% (Figure 2). The most common preoperative comorbid conditions were hypertension (74.3%), fluid and electrolyte disorders (32.4%), and anemia (24.9%). However, the largest relative increases were observed for sleep apnea (1.2% to 4.3%), drug abuse (0.7% to 1.9%), weight loss (3.1% to 7.1%), and obesity (2.6% to 5.4%; P < .0001).

Figure 2.

Trends in individual cumulative comorbidity burden among hip fracture patients between 2006 and 2016.

In respect to complications (Table 3 and Figure 3), the most commonly seen complications (other than blood transfusions) were cardiovascular, renal, and pulmonary complications. A significant upward trend was observed for the incidence of acute renal failure. To the contrary, the rates of acute myocardial infarction, pneumonia, venous thromboembolism, and hemorrhage/hematoma declined. Overall mortality rate declined from 3.4 to 3.1 per 1000 inpatient days (P < .0001), while the use of blood transfusions (P = .23) showed no significant alteration. The incidence for the other studied outcomes did not change significantly over time. In addition, inpatient falls after the surgery appeared to be increasing in more recent years after initially decreasing; however, the linear trend was not significant (P = .401).

Figure 3.

Trends in the rates of postoperative complications among hip fracture patients between 2006 and 2016.