Increased Mortality in Hip Fracture Patients With Aortic Stenosis and Pulmonary Hypertension Compared to Aortic Stenosis Alone.

Authors

Christian B. Cignoni, HCA HealthcareFollow
Steven K M Vuu, HCA HealthcareFollow
Huazhi Liu, HCA HealthcareFollow
Jason M. Clark, HCA HealthcareFollow
Carrie D. Watson, HCA HealthcareFollow
Larwrence R. Ferber, HCA HealthcareFollow
Winston T. Richards, HCA HealthcareFollow
Darwin N. Ang, HCA HealthcareFollow

Division

North Florida

Hospital

Ocala Regional Medical Center

Document Type

Manuscript

Publication Date

11-29-2021

Keywords

aortic stenosis, isolated hip fracture, mortality, pulmonary hypertension, trauma

Disciplines

Cardiovascular Diseases | Surgery | Trauma

Abstract

INTRODUCTION: Hip fractures are one of the most common traumatic injuries in the United States, secondary to an aging population. Multiple comorbidities are found in patients who present to trauma centers (TCs) with isolated hip fractures (IHFs) including significant cardiac disease. Aortic stenosis (AS) among these patients has been recently shown to increase mortality. However, factors leading to death from AS are unknown. We hypothesize that pulmonary hypertension (PH) is a significant mechanism of death among IHF patients with AS.

METHODS: This is a multicenter retrospective cohort study examining IHF patients treated at Level I and II TCs within a large hospital system from 2015 to 2019. Patients who had IHFs and AS were compared to those who had IHFs, AS, and PH. Multivariable logistic regression was used to risk adjust by age, race, insurance status, and comorbidities. The primary outcome was inpatient mortality. The secondary outcomes were hospital-acquired complications.

RESULTS: A total of 1388 IHF patients with AS were included in the study. Eleven percent of these patients also had PH. The crude mortality rate was higher if IHF patients had both AS and PH compared to IHF with AS alone (9% vs 3.7%,

CONCLUSION: In patients with IHFs, PH and AS increase the likelihood of inpatient mortality by 2.5 times compared to AS alone. Pulmonary hypertension among IHF patients with AS is an important risk factor to identify in the preoperative period. Early identification may lead to better perioperative management and counseling of patients at higher risk of complications.

Publisher or Conference

The American Surgeon

Recommended Citation

Cignoni CB, Vuu SKM, Liu H, et al. Increased Mortality in Hip Fracture Patients With Aortic Stenosis and Pulmonary Hypertension Compared to Aortic Stenosis Alone [published online ahead of print, 2021 Nov 29]. Am Surg. 2021;31348211054525. doi:10.1177/00031348211054525