Neoplastic pathologic hip fractures are associated with a higher risk of post-operative bleeding and thromboembolic events

Marcos R Gonzalez; Daniel Karczewski; Angad Ds Bedi; Hayley Denwood; Santiago A Lozano-Calderon

doi:10.1016/j.suronc.2024.102076

Neoplastic pathologic hip fractures are associated with a higher risk of post-operative bleeding and thromboembolic events

Surg Oncol. 2024 Apr 9:54:102076. doi: 10.1016/j.suronc.2024.102076. Online ahead of print.

Authors

Marcos R Gonzalez¹, Daniel Karczewski¹, Angad Ds Bedi², Hayley Denwood¹, Santiago A Lozano-Calderon³

Affiliations

¹ Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02144, USA.
² Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02144, USA; Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02144, USA. Electronic address: slozanocalderon@mgh.harvard.edu.

PMID: 38608626
DOI: 10.1016/j.suronc.2024.102076

Abstract

Introduction: Surgical treatment of hip fractures leads to significant post-operative complications. Although pathologic fractures (PF) are associated with worse outcomes, most studies do not differentiate between etiology (neoplastic and non-neoplastic PF). We seek to compare 30-day complication rates between 1) native hip fractures and neoplastic PF, and 2) neoplastic and non-neoplastic PF.

Materials and methods: A total of 127,819 patients with hip fractures and 5104 with PF diagnosed from 2005 to 2021 were retrieved from the NSQIP database. We included 1843 patients with neoplastic PF and 3261 with non-neoplastic PF. Demographics, pre-operative labs and co-morbidities, and post-operative outcomes were analyzed. Propensity-score matching was conducted to control for confounders.

Results: Patients with a neoplastic PF had a significantly higher rate of deep venous thrombosis (DVT) (4 % vs 1.2 %, p = 0.001) and pulmonary embolism (PE) (2.4 % vs 0.7 %, p < 0.001), than native hip fractures. Rates of post-operative bleeding were significantly higher in the neoplastic PF group (29.3 % vs 23.9 %, p < 0.001) than non-neoplastic PF. No differences in soft tissue complications were found. When comparing neoplastic and non-neoplastic PF, the former had a higher rate of PE (2.5 % vs 1.0 %, p = 0.015) and post-operative bleeding (27.6 % vs 22.0 %, p = 0.009). Unplanned readmission rates and 30-day mortality rate were also higher in the neoplastic PF group.

Conclusion: Neoplastic PF of the hip are associated with higher risk of thromboembolic event rates and post-operative bleeding than both native hip fractures and non-neoplastic PF. No differences in rates of soft tissue complications were found between groups.

Keywords: Bone metastasis; Hip fracture; Outcomes; Pathologic fracture.