Outcomes following surgical management of femoral neck fractures in elderly dialysis-dependent patients

Varun Puvanesarajah, Raj Amin, Rabia Qureshi, Babar Shafiq, Ben Stein, Hamid Hassanzadeh, Seth Yarboro

Research output: Contribution to journalArticle

Abstract

Introduction: Proximal femur fractures are one of the most common fractures observed in dialysis-dependent patients. Given the large comorbidity burden present in this patient population, more information is needed regarding post-operative outcomes. The goal of this study was to assess morbidity and mortality following operative fixation of femoral neck fractures in the dialysis-dependent elderly. Methods: The full set of medicare data from 2005 to 2014 was retrospectively analyzed. Elderly patients with femoral neck fractures were selected. Patients were stratified based on dialysis dependence. Post-operative morbidity and mortality outcomes were compared between the two populations. Adjusted odds were calculated to determine the effect of dialysis dependence on outcomes. Results: A total of 320,629 patients met the inclusion criteria. Of dialysis-dependent patients, 1504 patients underwent internal fixation and 2662 underwent arthroplasty. For both surgical cohorts, dialysis dependence was found to be associated with at least 1.9 times greater odds of mortality within 1 and 2 years post-operatively. Blood transfusions within 90 days and infections within 2 years were significantly increased in the dialysis-dependent study cohort. Dialysis dependence alone did not contribute to increased mechanical failure or major medical complications. Conclusion: Regardless of the surgery performed, dialysis dependence is a significant risk factor for major post-surgical morbidity and mortality after operative treatment of femoral neck fractures in this population. Increased mechanical failure in the internal fixation group was not observed. The increased risk associated with caring for this population should be understood when considering surgical intervention and counseling patients.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalArchives of Orthopaedic and Trauma Surgery
DOIs
StateAccepted/In press - Feb 10 2018

Keywords

  • Dialysis-dependent
  • Elderly
  • Femoral neck fracture
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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