Acute Crit Care.  2020 Feb;35(1):10-15. 10.4266/acc.2019.00745.

Elixhauser comorbidity measures-based risk factors associated with 30-day mortality in elderly population after femur fracture surgery: a propensity scorematched retrospective case-control study

• Kim D
• Jo H
• Lee Y
• Kim KO

• KMID: 2500945
• DOI: http://doi.org/10.4266/acc.2019.00745

Abstract

Background
As the average life expectancy increases, anesthesiologists confront unique challenges in the perioperative care of elderly patients who have significant comorbidities. In this study, we evaluated Elixhauser comorbidity measures-based risk factors associated with 30day mortality in patients aged 66 years and older who underwent femur fracture surgery. Methods: We used the Medical Information Mart for Intensive Care III which contains the medical records of patients admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center in the United States between 2001 and 2012 to identify patients admitted to the ICU after femur fracture surgery (n=209). Patients who died within 30 days of admission (case group, n=49) were propensity score-matched to patients who did not (control group, n=98). The variables for matching were age, sex, race, anemia (hemoglobin ≤10 g/dl), and malignancy. We attempted to explain mortality via nine independent factors: hypertension, uncomplicated diabetes, complicated diabetes, congestive heart failure (CHF), cardiac arrhythmias, chronic pulmonary disease, renal failure, neurological disorders other than paralysis, and peripheral vascular disease. Results: Logistic regression identified three significant risk factors: CHF, arrhythmias, and neurological disorders other than paralysis. The odds ratio (OR) for the 30-day mortality of CHF was 4.99 (95% confidence interval [CI], 2.18 to 12.06). The equivalent ORs for cardiac arrhythmias and neurological disorders other than paralysis were 2.61 (95% CI, 1.14 to 6.21) and 2.40 (95% CI, 0.95 to 6.48), respectively. Conclusions: Identifying patients with these risk factors (CHF, arrhythmias, and neurological disorders other than paralysis) will assist clinicians with perioperative planning and provide caregivers with valuable information for decision-making.

Keyword

elderly; femur fracture; mortality; orthopedic; risk factor

Figure

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  Figure 1. Flowchart of the study protocol. Case-control selection. ICU: intensive care unit; ICD 9: International Classification of Diseases, Ninth Revision.

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  Figure 2. Forest plot of odds ratios for mortality, comparing case and control groups. (A) To explain 30-day mortality in patients after femur surgery, the nine candidate co-morbid factors are arbitrarily placed in the model. (B) Using the stepwise selection method, the factor list is shortened. The shortened model showed that congestive heart failure, cardiac arrhythmias, and other neurological disordersa are significant predictors of 30-day mortality. a Other neurological disorders indicates neurological disorders other than paralysis, according to the Elixhauser Comorbidity measures [10]. CI: confidence interval.

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