Association Between Cemented vs Cementless Hemiarthroplasty and Short-Term Change of In-Hospital Mortality in Elderly Patients with Femoral Neck Fracture: A Propensity-Score Matching Analysis in a Multicenter Database

Abstract

Takahisa Ogawa,1 Toshitaka Yoshii,1 Atsushi Okawa,1 Kiyohide Fushimi,2 Tetsuya Jinno1,3 1Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; 2Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan; 3Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, JapanCorrespondence: Tetsuya JinnoDepartment of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, JapanTel [phone]Email [email protected] OgawaDepartment of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, JapanTel [phone]Email [email protected]: Cemented hemiarthroplasty is recommended for the vulnerable hip fracture population because of beneficial long-term outcomes. However, the association between cemented hemiarthroplasty and short-term mortality is controversial. To increase a preparedness of potential complication after cemented hemiarthroplasty, we aimed to evaluate the trajectory of the effect of cemented hemiarthroplasty on short-term in-hospital outcomes.Methods: We investigated in-hospital mortality and complications between cemented hemiarthroplasty and cementless hemiarthroplasty using a nationwide multicenter database from 2010 to 2016 with a propensity-score matching analysis. We analyzed in-hospital mortality from 1 to 14 days after surgery. We also investigated in-hospital complications that may associate with mortality.Results: After matching of 31,322 cases, we found no significant difference in 30-day in-hospital mortality between the cemented and cementless hemiarthroplasty groups (hazard ratio, HR [95% confidence interval, CI], 1.2 [0.89– 1.6], p = 0.23). However, the 1- to 10-day postoperative mortality rates were significantly higher in the cemented group and the association becomes weaker as the postoperative period increased (day 1; HR [95% CI]: 3.5 [1.6– 7.68]; day 10; HR [95% CI]: 1.59 [1.07– 2.37]). The incidence of stroke and intensive care unit (ICU) admission was also significantly higher in the cemented group.Conclusion: Cemented hemiarthroplasty was not significantly associated with an increase in overall in-hospital mortality but was significantly associated with short-term mortality from 1-day to 10-day after surgery. The incidence of stroke and ICU admission was also significantly higher in the cemented group. Surgeons should pay more attention to the risk of mortality and stroke in patients undergoing cemented hemiarthroplasty, especially in the early days of hospitalization.Keywords: national database, complication, geriatric fracture, stroke, intensive care unit admission, ICU admission

Keywords

• national database
• complication
• geriatric fracture
• stroke
• intensive care unit (icu) admission