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Seasonality of mortality and in‐hospital complications in hip fracture surgery: Retrospective cohort research using a nationwide inpatient database
Author(s) -
Ogawa Takahisa,
Yoshii Toshitaka,
Higuchi Masaya,
Morishita Shingo,
Fushimi Kiyohide,
Fujiwara Takeo,
Okawa Atsushi
Publication year - 2021
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/ggi.14153
Subject(s) - medicine , hip fracture , hazard ratio , retrospective cohort study , proportional hazards model , cohort study , logistic regression , cohort , epidemiology , seasonality , emergency medicine , osteoporosis , surgery , confidence interval , statistics , mathematics
Aim Among older patients undergoing hip fracture surgery, previous studies have shown a seasonal variation of in‐hospital surgical complications. However, little is known about seasonal effects on mortality and systemic complications after hip fracture surgery. In the present study, we evaluated whether mortality and in‐hospital systemic complications are influenced by seasonal differences. Methods We enrolled patients from a nationwide database who underwent hip fracture surgery between 2010 and 2018. The primary outcome was in‐hospital mortality. The secondary outcomes were in‐hospital systemic complications. The association between the seasonality and in‐hospital outcomes was investigated using multivariable Cox, logistic regression and causal mediation analysis. Results With 425 856 patients (mean age 83.5 years; 79% women), overall in‐hospital mortality was 5324 (1.2%). Fall and winter were associated with a higher mortality than spring (hazard ratio [HR] 1.16; P < 0.001; HR 1.14; P = 0.001, respectively). Across all the seasons, there were 36 834 overall systemic complications (8.6%), with respiratory infection being the most frequent (18 637 [4.4%]). Among these complications, only respiratory infection showed seasonal variation, with a higher prevalence in fall and winter. The mediated effect of respiratory infection on mortality was significantly higher in fall and winter compared with spring (fall, HR 1.06, proportion mediated 36.7%; winter, HR 1.14, proportion mediated 55.0%; all P < 0.001). Conclusions We found a significantly higher mortality in fall and winter after hip fracture surgery. Specifically, in winter, the increased in‐hospital death was largely attributed to the increased incidence of respiratory infection. Geriatr Gerontol Int 2021; 21: 398–403 .