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South Med J. 2012 Jun;105(6):306-10. doi: 10.1097/SMJ.0b013e3182574bfd.

Relation between prefracture characteristics and perioperative complications in the elderly adult patient with hip fracture.

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  • 1Departments of Orthopedics and Medicine, Duke University Medical Center, Durham, NC, USA.



The exact relation among patient prefracture characteristics such as age, American Society of Anesthesiologists (ASA) class, fracture type, and prefracture mobility status with perioperative complications in elderly adult patients with hip fracture is still unclear. The aim of the study was to assess the relations among patient prefracture characteristics and perioperative complications.


Patients 65 years old and older admitted to our institution between January 2006 and May 2010 with the diagnosis of a low-energy hip fracture were retrospectively reviewed. A total of 389 patients met the inclusion criteria and were analyzed in this investigation. Patient prefracture characteristics, comorbidities, and surgical and hospital courses were reviewed.


Using logistic regression analysis, ASA class was found to be the only significant predictor of a patient having at least one or more perioperative complications (odds ratio [OR] 2.007). In addition to ASA class, prefracture mobility status was a significant predictor of delirium (OR 1.39) and pneumonia (OR 1.77), advanced age was a significant predictor of congestive heart failure (OR 1.73), and fracture type was a significant predictor of pneumonia (OR 1.6). None of the examined prefracture characteristics was found to be a significant predictor of pulmonary embolus, deep venous thrombosis, surgical wounds, transfusions, urinary tract infection, or death.


At our institution, certain patient prefracture characteristics, particularly high ASA class, are related to certain perioperative complications. Recognition of patients who possess these risk factors can be used to alert the caregiving team about a potentially complicated hospital course.

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