Hips don’t lie: Elderly patients with anaemia must watch out

New Delhi: Elderly patients with hip fractures face a higher risk of mortality if they have anaemia or abnormal sodium levels before undergoing surgery.
This was revealed in a study by All India Institute of Medical Sciences (AIIMS) and recently published in PuBMed.

According to the study, anaemia was the most common detectable laboratory irregularity among patients over 50 years admitted with hip fractures at the AIIMS trauma centre, followed by abnormal sodium levels.
“Pre-existing conditions such as low red blood cell count and imbalanced electrolytes can significantly impact the survival outcomes of senior people who suffer from hip fractures and require surgical intervention,” the researchers said.
Dr Vijay Sharma, a professor in the orthopaedic surgery department at the AIIMS Trauma Centre, shared the findings of the study on hip fracture patients. “We found that 1 in 10 patients died within three months of hip fractures. Anaemia was seen in three out of four patients and hyponatremia (a condition where sodium levels in blood are lower than normal) in one among three patients. Patients suffering from anaemia or hyponatremia faced a nearly four-fold increased mortality risk compared to those without these conditions," he said.
The study highlights the significant impact of these medical conditions on the mortality rate of hip fracture patients, even when factors such as age and other health issues were accounted for.
The research included 283 hip fracture patients. Among the study population, 152 (54%) were female. The research conducted revealed that a significant majority of patients, specifically 92%, exhibited a minimum of one irregularity in their standard laboratory tests. Furthermore, it was found that 69% of patients in the study had at least one coexisting medical condition. Among the laboratory abnormalities identified, anaemia was found to be the most prevalent (70.3%). Concurrently, the most frequently diagnosed comorbidity among the patients was hypertension (45.9%).
The authors of the study are Dr Jaiben George and doctors from the department of orthopaedic surgery, JPNA trauma centre — Dr Kamran Farooque, Dr Vijay Sharma, Dr Vivek Trikha and Dr Samarth Mittal.
“Indian elderly patients sustaining hip fractures were about five times more likely to die than younger patients,” the researchers said. Surprisingly, the mortality rate associated with hip fractures surpassed that of several other serious health conditions. The death rate among hip fracture patients was found to be higher than the mortality rates of people diagnosed with myocardial infarction, breast cancer or cervical cancer.
The study tracked 97.2% of patients for 90 days after treatment. During this period, 9.8% patients passed away. The mortality rate during hospitalization was 2.5%. Additionally, seven patients underwent a second surgery. The mortality rate was higher among patients who had a re-operation at 14.3%, compared to 9.7% for those who did not require additional surgery.
Researchers concluded that about nine out of every ten patients had abnormal test results, with anaemia and abnormal sodium levels being the most common. The most crucial pre-operative tests affecting mortality were haemoglobin, sodium, urea and creatinine levels. Therefore, any irregularities in these tests should be thoroughly addressed.
The presence of comorbidities generally increased the risk of mortality, although the impact varied depending on the specific condition. Patients with renal or neurological diseases had a higher risk of mortality, while common comorbidities such as hypertension and diabetes did not show a significant association with mortality.
The study's findings contribute to the development of hip fracture care pathways that focus on correcting abnormalities that substantially influence mortality. By identifying and addressing these critical factors, healthcare providers can work towards improving outcomes for patients.