Outcomes following surgery for fractured neck of femur in dialysis patients: a 5-year review from a district general hospital in the United Kingdom

摘要

Background Neck of femur fractures are associated with high mortality and have increased prevalence in dialysis patients. Delays in operating on dialysis patients can occur as a result of logistical or medical issues; it has previously been shown that delays on operating on neck of femur fractures in the general population results in increased mortality. Methods Medical records of 27 dialysis patients admitted to a large district general hospital in the UK with a fractured neck of femur between January 2009 and January 2014 were analysed alongside records of 27 age and sex-matched non-dialysis patients. Fisher’s exact test and the unpaired t test were applied to data to explore outcomes. Odds ratio was also used to compare mortality between the dialysis and non-dialysis groups. Results Thirty-day mortality amongst dialysis patients was 22?%, compared to 7?% in the non-dialysis cohort. One-year mortality amongst dialysis patients was 70?%, compared to 15?% in the non-dialysis cohort (odds ratio 13.7 (3.56–52.4, 95?% confidence interval; p =?0.0001)). Average length of survival in dialysis patients overall was 311?days; average length of survival if the patient was operated on within 48?h of admission was 450?days (192–708?days, 95?% confidence interval) and was 224?days (45–402, 95?% confidence interval) if operated on after more than 48?h of admission ( p =?0.16). Conclusions Dialysis patients had higher post-operative mortality than the non-dialysis cohort. Odds ratio for death was significantly greater at one-year in the cohort of dialysis patients compared to the non-dialysis patients. Delay to operation amongst the dialysis patient cohort did not contribute significantly to mortality in this study. The higher rates of coronary artery disease, diabetes mellitus and malignancy may confound mortality amongst patients on dialysis who sustain a fractured neck of femur. Limitations of this study included small patient numbers, data from only one centre being used, and some missing data for certain patients.