Pelvic fracture carries high burden of morbidity, mortality
MedWire News: People who suffer a pelvic fracture face a high burden of morbidity and mortality, shows data from a population-based study.
The study authors call for urgent action to improve therapeutic strategies in pelvic fracture patients in order to improve patient outcomes.
The research was undertaken by a pan-European team led by Kassim Javaid (University of Oxford, UK) and is reported in Osteoporosis International.
The team analyzed information from the SIDIAPQ (Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària) database, which contains the medical records of patients attending 1365 primary-care clinicians in Catalonia, in north-east Spain.
A total of 1,118,173 patients aged 40 years and older were eligible for the study. Between 2007 and 2009, 1356 of these individuals suffered a fracture of the pelvis, giving a crude incidence rate of 4.35 per 10,000 person-years at risk (PYARs).
Further analysis showed that the incidence rate was higher in women than in men (5.82 vs 2.73 per 10,000 PYARs), although the gender difference became statistically significant only among the over-60s, at a hazard ratio (HR) of 0.40.
Just 801 (59.1%) patients with a pelvis fracture were admitted to hospital, Javaid et al report. Patients who were hospitalized were more likely to be male, older, and thinner than those who were not hospitalized.
The median length of hospital stay was 9 days (range 5-16 days), with men and older patients being admitted for longer, on average, than women and younger patients.
Mortality following pelvic fracture was high, at cumulative rates of 5.1% at 3 months, 9.3% at 1 year, and 13.9% at 3 years. In a fracture-free reference cohort, cumulative mortality at these time points was 0.7%, 3.5%, and 10.2%, respectively.
Mortality was higher at each time point for hospitalized versus non-hospitalized patients; HRs were 2.38 with adjustment for age and gender and 2.53 with further adjustment for body mass index (BMI).
In multivariate analysis, older age, male gender, and hospital admission were each significantly and independently associated with increased mortality, at adjusted HRs of 1.08 per 1-year increase, 1.87, and 1.76, respectively.
Finally, BMI showed an inverse association with fracture risk, at adjusted HRs of 0.83, 0.67, and 0.60 for overweight, somewhat obese, and very obese individuals, as compared with normal-weight individuals.
"Our findings suggest a significant healthcare burden from pelvic fractures," write Javaid et al. "We also demonstrate that mortality following a pelvis fracture is increased at least for 3 years."
They conclude: "Further work is required to identify the optimal post-fracture therapeutic strategy to improve outcomes in this elderly patient group."
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By Joanna Lyford