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Abstract: PO1692

Mortality Outcomes of Dialysis Patients Who Sustained Neck of Femur Fractures in a Tertiary London Renal Centre

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Reeve, Eleanor Isabel, St Helier Hospital, Carshalton, Surrey, United Kingdom
  • Kapila, Diya, St Helier Hospital, Carshalton, Surrey, United Kingdom
  • Singh, Nivi, St Helier Hospital, Carshalton, Surrey, United Kingdom
  • Sood, Bhrigu Raj, St Helier Hospital, Carshalton, Surrey, United Kingdom
Background

Patients with end stage renal disease have an increased risk of fractures, including neck of femur (NOF) fractures, partly due to bone mineral disorders. Studies show higher post-operative mortality rates in this group, attributed to abnormal vitamin D metabolism, challenges with fluid status, and dialysis sessions impeding physical therapy rehabilitation. St Helier hospital has an onsite tertiary renal centre and the Hip Fracture Unit has been ranked as one of the best performing in the country. We sought to establish if this on-site standardised local practice translated to reduced mortality outcomes in dialysis patients who sustained NOF fractures.

Methods

We performed a retrospective analysis of the 30 day mortality of dialysis patients sustaining NOF fractures between April 2011 and July 2018. Patients with NOF fractures were identified from the National Hip Fracture Database and dialysis patients from the renal unit database. We reviewed demographics, pre and post-surgical parameters and 30-day unadjusted mortality.

Results

We identified 3164 NOF patients and 46 of these patients were on dialysis (n=46). 43 were on haemodialysis and 3 were on peritoneal dialysis. The dialysis cohort included 20 females and 26 males and average age was 77 years (53-95). ASA grades were 3 in 23 patients, 4 in 22 patients, and 5 in 1 patient. 29 operations were conducted under general anaesthesia, 16 under spinal anaesthesia and 1 patient had non-operative management of a subcapital fracture. All patients had a pre-operative review by an orthogeriatrician and remained under joint care of the orthopaedic, orthogeriatric and renal teams. 30-day unadjusted mortality for the dialysis cohort was 8.70% (4 deaths), compared to 7.60% for the general cohort (RR 1.144, CI 0.445-2.942, P = 0.7801). Average length of stay for the dialysis cohort was 26 days (5-87). Average length of survival for the dialysis cohort was 801 days following admission.

Conclusion

Previous studies have demonstrated 2 to 4 fold increased mortality in dialysis patients with NOF fractures. Our data shows that patients on renal replacement therapy did not have higher 30-day mortality compared to the general cohort. A multidisciplinary service with close collaboration between specialities can lead to good outcomes in this high risk population.