Clinical, Hematologic, and Inflammatory Factors Associated with Early Mortality and Postoperative ICU Admission After Geriatric Hip Fracture Surgery
TL;DR
Early outcomes were associated with multiple baseline, inflammatory, and perioperative factors, and the mortality findings remain exploratory and require confirmation in prospectively characterized cohorts.
Abstract
Background: This study evaluated whether routinely available admission hematologic and inflammatory markers remained associated with postoperative intensive care unit (ICU) admission and 1-month mortality when considered alongside established clinical and perioperative factors. Methods: We retrospectively analyzed 598 patients aged 65 years or older who underwent proximal femoral nailing (PFN) or hemiarthroplasty for hip fracture between October 2021 and October 2025. Admission laboratory values were obtained from the first blood tests at presentation. The primary outcome was 1-month mortality, and the secondary outcome was postoperative ICU admission. Group comparisons used the Mann–Whitney U and chi-square tests, and multivariable logistic regression was used for adjusted analyses. Given the limited number of deaths, the mortality analysis was considered exploratory. Results: Among 594 patients in the clinical ICU comparison, 228 (38.4%) were admitted to the ICU. One-month mortality occurred in 41 of 596 patients (6.9%). ICU admission was associated with age (OR 1.04, 95% CI 1.01–1.06), ASA score (OR 2.04, 95% CI 1.45–2.87), and number of packed red blood cell (PRBC) units transfused (OR 1.60, 95% CI 1.36–1.88). Mortality was associated with age (OR 1.07, 95% CI 1.02–1.12), male sex (OR 3.30, 95% CI 1.66–6.56), the fracture-treatment pathway represented by hemiarthroplasty versus PFN (OR 3.69, 95% CI 1.78–7.64), CRP per 10 mg/L (OR 1.05, 95% CI 1.01–1.10), and greater PRBC exposure (OR 1.37 per unit, 95% CI 1.11–1.70). RDW-CV was not associated with either outcome after adjustment. Conclusions: The observed associations with procedure and transfusion should not be interpreted as causal effects. Early outcomes were associated with multiple baseline, inflammatory, and perioperative factors, and the mortality findings remain exploratory and require confirmation in prospectively characterized cohorts.