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RAISED SERUM UREA CONCENTRATION ON ADMISSION FOLLOWING HIP FRACTURE – A HIGH-RISK GROUP?

Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB

To assess the relationship between preoperative urea concentration and mortality in patients with hip fractures requiring surgery, we carried out a prospective observational study of 1230 consecutive patients admitted to a single trauma unit with a hip fracture, required surgery.

Results: The mean age was 80 years (range 17–101) and 931 (77%) were female. 669 patients (54%) had intracapsular fractures, 547 patients (45%) had extra-capsular fractures and 14 patients (1%) had periprosthetic fractures. 760 (62%) patients were admitted from their own homes, 178 (15%) from residential homes, 150 (12%) from nursing homes and 123 (10%) from warden-aided homes. 644 (53%) were independently mobile before injury, 311 (26%) used walking aids, 241 (20%) were mobile with the use of a frame and 24 (2%) were unable to walk. 371 (32%) patients had a mini mental test score of less than 7. 49 (4%) were known to have renal disease and 106 (9%) had diabetes.

The 30-day mortality was 9.8% and the 90-day mortality was 19.9%. The mortality at 1 year was 29.0% and at 2 years was 30.2%. There is a clear relationship between a raised admission urea concentration and mortality at 90 days, 1 year and 2 years. Abnormalities of serum sodium and potassium concentration did not influence mortality.

Conclusion: Mortality is high following hip fracture. Patients admitted with a raised serum urea and treated with operative methods are at increased risk of death at all the time intervals analysed, up to and including 2 years. This group of patients may require a separate care pathway that provides more intensive management of fluid and electrolyte balance.

The abstracts were prepared by Mr Tim Briggs. (Editoral Secretary 2003/4) Correspondence should be addressed to him at Lane Farm, Chapel Lane, Totternhoe, Dunstable, Bedfordshire LU6 2BZ, United Kingdom