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TRENDS AND OUTCOMES OF PATIENTS HOSPITALIZED WITH HIP FRACTURE WHO HAVE UNDERLYING AORTIC VALVE STENOSIS: A NATIONWIDE INPATIENT SAMPLE ANALYSIS 2008-2019
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TRENDS AND OUTCOMES OF PATIENTS HOSPITALIZED WITH HIP FRACTURE WHO HAVE UNDERLYING AORTIC VALVE STENOSIS: A NATIONWIDE INPATIENT SAMPLE ANALYSIS 2008-2019

Shahzad Hassan, Tilachan Parajuli, Abhishek Dutta, Shivani Mehta and Waqas Qureshi
Journal of the American College of Cardiology, Vol.81(8 Suppl), pp.1993-1993
03/07/2023
DOI: 10.1016/S0735-1097(23)02437-3
url
https://doi.org/10.1016/S0735-1097(23)02437-3View
Published (Version of record) Open Access

Abstract

Background Hip fracture is common cause of hospitalization in US population especially those above 75 years of age who may also have underlying aortic stenosis(AS). We aim to study trends, outcomes and predictors of mortality in this group of hospitalized patients. Methods We conducted retrospective data analysis of nationwide inpatient sample from year 2008-2019. Patients with hip fracture were identified and aortic stenosis subgroup was created using ICD-9 & ICD-10 codes. Baseline characteristics, in-hospital outcomes and trends were studied and compared among groups based on the presence or absence of AS. Results 2,851,129 patients with hip fracture were identified on weighted analysis. 94,295(3.31%) patients had underlying AS. Patients in AS group had higher mean age and burden of cardiovascular co-morbidities like coronary artery disease, peripheral vascular disease, pulmonary hypertension, congestive heart failure and cardiac arrhythmias.. AS group had higher post-operative mortality compared to non-AS group (5.5% vs 1.62%, p <0.01). At baseline, congestive heart failure (OR, 2.11[CI, 1.9-2.3]), age above 85 years (OR, 4.4[CI, 3.1-6.4]), cardiac arrhythmias (OR, 2.4[CI, 2.2-2.6]), end stage renal disease (OR, 2.7[CI, 2.2-3.2]), malnutrition (OR, 2.3[CI, 2.0-2.6]) and AS (OR, 1.2[CI, 1.08-1.5]) were associated with higher adjusted odds of mortality. AS was also associated with higher adjusted odds of postoperative complications like acute myocardial infarction (OR, 1.2 [CI], 1.02-1.44]), cardiogenic shock (OR, 2.04[CI, 1.35-2.96], acute renal failure (OR, 1.15[CI, 1.06-1.23]) and acute ischemic stroke (OR, 1.58[CI, 1.37-1.83]). There was no difference in length of stay in case of surgery in both groups (mean 5 days) but higher cost in AS group (mean $56,338 vs $50,937). There was statistically significant decline in post-operative in-hospital mortality in both groups from 2008-2019(8.9% to 6.27% vs 11.05% to 6.33%, p trend <0.05). Conclusion AS is associated with higher cardiac complications and mortality in hospitalized patients with hip fracture. There was statistically significant decline in post-operative in-hospital mortality in both groups since 2008.

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