Abstract 4989: Age and Gender-Based Incidence of Myocardial Infarction Following Hip Fracture Repair: A Population-Based Study
Background The one-year mortality following hip fracture repair exceeds 20%, far greater than the predicted composite rate of myocardial infarction (MI) and/or death for orthopedic procedures (2007 ACC/AHA Perioperative Guideline). Very little is known specifically about incidence of MI following urgent hip fracture repair.
Methods and Results Population-based historical cohort of 1195 hip fracture repairs performed in Olmsted County, MN residents between January 1, 1988 and December 31, 2002. Data were obtained through complete medical record review of all care delivered during the year following the incident surgery (inpatient, outpatient and nursing home care). Biochemical or electrocardiographic evidence was required for diagnosis of MI. Mean age 84.2 years, 80% female, 99% Caucasian. The overall postoperative one-year incidence of MI was 220 per 1000 person years. Incidence did not differ between genders (200 and 144 per 1000 person years for women and men respectively, p=0.1) or age groups. The in-hospital incidence of postoperative MI for both genders and all age groups exceeded 7900 per 1000 patient years indicating that most postoperative MI’s occur soon after surgery (88% within 7 days). Patients with an MI during the first year following hip fracture repair were twice as likely to die (HR 2.2, 95% CI 1.7–2.9).
Conclusion Hip fracture repair should be considered a special population and classified as a high-risk procedure in the ACC/AHA Perioperative Guideline. With 88% of MI’s occurring during the index hospitalization, research is needed to determine what early perioperative medical interventions could improve outcomes.
This research has received full or partial funding support from the American Heart Association, AHA National Center.