Polypharmacy and adverse outcomes after hip fracture surgery
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RESEARCH ARTICLE
Open Access
Polypharmacy and adverse outcomes after hip fracture surgery Maria Härstedt1, Cecilia Rogmark2, Richard Sutton3, Olle Melander1,4 and Artur Fedorowski1,5*
Abstract Background: We aimed to explore the effects of polypharmacy and specific drug classes on readmissions and mortality after hip surgery. Methods: We analyzed data on 272 consecutive hip fracture patients (72.1% females; age 82 ± 9 years) who underwent acute hip replacement. We collected detailed data on the pharmacological treatment upon admission and discharge. Patients were followed up over a period of 6 months after discharge using the Swedish National Hospital Discharge Register and the Swedish National Cause of Death Register. Results: After 6 months, 86 patients (31.6%) were readmitted, while 36 patients (13.2%) died. The total number of medications upon discharge was predictive of rehospitalization (odds ratio (OR) 1.08, 95%CI 1.01–1.17, p = 0.030) but not predictive of mortality. The use of antiosteoporotic agents (OR 1.86, 95%CI 1.06–3.26, p = 0.03), SSRIs (OR 1.90, 95%CI 1.06–3.42, p = 0.03), and eye drops (OR 4.12, 95%CI 1.89–8.97, p = 0.0004) were predictive of rehospitalization. Treatment with vitamin K antagonists (OR 4.29, 95%CI 1.19–15.39, p = 0.026), thiazides (OR 4.10, 95%CI 1.30–12.91, p = 0.016), and tramadol (OR 2.84, 95%CI 1.17–6.90, p = 0.021) predicted readmissions due to a new fall/trauma. Conclusions: The total number of medications, use of antiosteoporotic agents, SSRIs, and eye drops predicted rehospitalization after hip fracture surgery, while use of vitamin K antagonists, thiazides, and tramadol was associated with readmissions due to a traumatic fall. Trial registration: Hip fractures and polypharmacy in the elderly. Stimulus Project for the Elderly 2009-2011 (Reg no 2009-11-26). Swedish National Board of Health and Welfare. Keywords: Hip fracture, Patient readmission, Mortality, Polypharmacy
Background Hip fracture in the elderly, following the trend in population aging in developed countries, is a common cause of hospital admission [1–4]. The mean age of typical patients with acute hip fracture is high, over 80 years [5], which implies multiple comorbidities combined with polypharmacy [5–7]. It is estimated that patients who suffer hip fracture take, on average, six different medications, which have been identified as an independent risk factor for falls in the elderly [8, 9]. Moreover, two thirds of these patients take drugs that raise the fall risk [9]. In recent years, there has been a growing interest in optimizing pharmacological
Methods
* Correspondence: [email protected] 1 Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, SE 205-02 Malmö, Sweden 5 Department of Cardiology, Skåne University Hospital, Inga Marie Nilssons gata 46, SE 205-02 Malmö, Sweden Full list of author information is available at the end of the article
Between November 2009 and June 2011, we enrolled 304 consecutive patients who were admitted to the Department of Orthopaedics a
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