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Valerie A. Lawrence, MD; Susan G. Hilsenbeck, PhD; Helaine Noveck, MPH; Roy M. Poses, MD; Jeffrey L. Carson, MD

Arch Intern Med. 2002;162:2053-2057.

Background  Most evidence guiding perioperative medical risk management of patients undergoing hip fracture repair focuses on cardiac and thromboembolic risk. Little is known of the relative clinical importance of other complications.

Objective  To systematically map incidence and outcomes of a broad spectrum of medical complications after hip fracture repair.

Methods  Retrospective cohort study of patients 60 years or older in 20 academic, community, and Veterans Affairs hospitals. Data on complications and mortality were abstracted from medical records by trained abstractors using standardized, pretested forms or the National Death Index.

Results  Of 8930 patients, 1737 (19%) had postoperative medical complications. Cardiac and pulmonary complications were most frequent (8% and 4% of patients, respectively). Similar numbers of patients had serious cardiac or pulmonary complications (2% and 3%, respectively). Other complications were gastrointestinal tract bleeding (2%), combined cardiopulmonary complications (1%), venous thromboembolism (1%), and transient ischemic attack or stroke (1%). Renal failure and septic shock were rare. After the index complication, 416 patients had 587 additional complications. Mortality was similar for serious cardiac or pulmonary complications (30 day: 22% and 17%, respectively; 1 year: 36% and 44%, respectively) and highest for patients with multiple complications (30 day: 29%-38%; 1 year: 43%-62%). Complications and death occurred significantly earlier for serious cardiac than for serious pulmonary complications (1 vs 4 days, 2 vs 8 days, P<.001); length of stay for patients surviving these complications was similar.

Conclusions  Most patients had no medical complications after hip fracture repair. Serious cardiac and pulmonary complications were equally important in frequency, mortality, and survivors' length of stay. Patients with multiple complications had especially poor prognosis.

From the Division of General Medicine, Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio (Dr Lawrence), and Division of Medical Oncology (Dr Hilsenbeck) and Division of General Medicine (Dr Lawrence), Department of Medicine, University of Texas Health Science Center at San Antonio; Division of General Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ (Ms Noveck and Dr Carson); and Division of General Internal Medicine, Department of Medicine, Brown University School of Medicine, Providence, RI, and Memorial Hospital of Rhode Island, Pawtucket (Dr Poses).

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