RESUMO
BACKGROUND: Hip fractures are a public health problem worldwide, and several factors are involved with post-operative mortality. The aim of this study was to identify the pre-operative factors associated with increased mortality in elderly patients with hip fractures in a developing country during the first post-operative year. METHODS: An ambidirectional cohort study was conducted with patientsâ¯≥â¯65â¯years of age who underwent hip surgery due to a hip fracture caused by a fall from a standing position. Socio-demographic data, time to surgery, and comorbidities measured by the Charlson Comorbidity Index (CCI) were recorded. One-year mortality from all causes was the primary outcome, and 30-day and 6-month mortality were the secondary outcomes. Log-rank test was used to evaluate survival, and Cox's proportional hazard regression was used to detect the factors associated with increased mortality. RESULTS: 478 patients who underwent hip surgery were included in this study. The mean age was 80.2⯱â¯9.9, and 297 (62%) were females. There were 150 (31.4%) deaths at the end of the first follow-up year, and the mean of surgical delay was 8.8â¯days⯱â¯6.4. Patients who underwent surgery during the first 4â¯days (Log-rank testâ¯<â¯0.001) after hip fracture occurred and patients with a CCIâ¯≤â¯2 (Log-rank testâ¯<â¯0.001) showed better survival (90%), comparing to mortality (52%) of patients with a CCIâ¯≥â¯3 and surgical delayâ¯>â¯4â¯days. The ageâ¯≥â¯80â¯years (Hazard ratio 2.55 (HR), 95% confidence interval (CI) 1.70 to 3.84, pâ¯<â¯0.001), CCIâ¯≥â¯3 (HR 1.61, 95% CI 1.14-2.26, p 0.006), surgical delayâ¯>â¯4â¯days (HR 2.41, 95% CI 1.38-4.21, p 0.006), and haemoglobinâ¯<â¯10â¯g/dl (HR 1.51, 95% CI 1.06-2.15, p 0.02) were associated with increased 1-year mortality. In addition, 30-day mortality was associated with ageâ¯≥â¯80â¯years (HR 4.15, 95% CI 1.98-8.70, pâ¯<â¯0.001), CCIâ¯≥â¯3 (HR 1.80, 95% CI 1.08-2.99, p 0.023), pre-surgical time >48â¯h (HR 3.0, 95% CI 1.58-5.92, p 0.001), and surgical delay >â¯4â¯days (HR 3.0, 95% CI 1.33-6.81, p 0.008); and 6-month mortality was associated with surgical delayâ¯>â¯4â¯days (HR 2.72, 95% CI 1.42-5.23, p 0.003), and haemoglobinâ¯<â¯10â¯g/dl (HR 1.56, 95% CI 1.04-2.33, pâ¯<â¯0.028). CONCLUSIONS: Surgical delay greater than 4â¯days and Charlson Comorbidity Indexâ¯≥â¯3 were found as factors associated with increased mortality, along with anaemiaâ¯<â¯10â¯g/dl and ageâ¯≥â¯80â¯years. A similar mortality rate was found in this study compared to the rates reported by the literature, despite a surgical delay of 8.8â¯days.