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Surgery for Hip Fx Cuts Mortality in NH Residents With Dementia

WEDNESDAY, May 9, 2018 -- For nursing home (NH) residents with dementia and hip fracture, surgical hip fracture repair is associated with lower mortality, according to a study published online May 7 in JAMA Internal Medicine.

Sarah D. Berry, M.D., M.P.H., from the Beth Israel Deaconess Medical School and Harvard Medical School in Boston, and colleagues conducted a retrospective cohort study of 3,083 NH residents (mean age, 84.2 years) with advanced dementia and hip fracture to compare survival for those undergoing surgical or non-surgical hip fracture repair.

Of the 3,083 residents with advanced dementia and hip fracture, 84.8 percent underwent surgical repair. The researchers found that 31.5 and 53.8 percent of surgically and non-surgically managed patients died, respectively, by the six-month follow-up. Surgically managed residents were less likely to die than those without surgery after inverse probability of treatment weighting (IPTW) modeling (adjusted hazard ratio, 0.88). For 2,007 residents who survived six months, less documented pain and fewer pressure ulcers were reported for those with surgical versus non-surgical management. Less pain and fewer pressure ulcers were reported in IPTW models (adjusted hazard ratios, 0.78 and 0.64, respectively). There was no between-group difference in antipsychotic drug use and physical restraint use.

"Surgical repair of a hip fracture was associated with lower mortality among NH residents with advanced dementia and should be considered together with the residents' goals of care in management decisions," the authors write.

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Posted: May 2018