Excess Mortality After Pelvic Fractures Among Older People

The study aimed to estimate excess mortality in patients aged 60 years or older up to 1 year after pelvic fracture compared with a population without pelvic fracture. In this retrospective population-based observational study, we use routine data from a large health insurance in Germany. For each patient with a first pelvic fracture between 2008 and 2010 (n = 5685 cases, 82% female, mean age 80 +/- 9 years), about 34 individuals without pelvic fracture (n = 193,159 controls) were frequency matched by sex, age at index date, and index month. We estimated survival probabilities in the first year after the index date separated for cases (further stratified into inpatient/outpatient treated or minor/major pelvic fractures) and controls using Kaplan-Meier curves. Additionally, time-dependent hazard ratios (HRs) measuring excess mortality in 4-week intervals upto 52 weeks were estimated by fitting Cox regression models including adjustment for relevant confounders. Twenty-one percent of cases and 11% of controls died within 1 year. HRs (95% confidence intervals) decreased from 3.9 (3.5-4.5) within the first 4 weeks to 1.4 (1.1-1.9) within weeks 49 to 52 after the index date. After full adjustment, HRs lowered substantially (3.0 [2.6-3.4] and 1.0 [0.8-1.4]) but were still significantly increased up to week 32. Adjusted HRs in women were lower than in men: 2.8 (2.4-3.2) and 1.0 (0.7-1.4) versus 3.8 (2.9-5.0) and 1.2 (0.6-2.3). We found a clear excess mortality among older people in the first 8 months after pelvic fracture even after full adjustment. Excess mortality was higher among men in the beginning as well as for inpatient treated persons. Absence of excess mortality was noticed for outpatient-treated persons within the first 3 months. When broken down into site-specific data, excess mortality was no longer significant for most pelvic fractures classified as minor. The only exception was fracture of pubis within the first 4 weeks. (C) 2017 American Society for Bone and Mineral Research.