To Örebro University

Hip fractures have been a major concern within the healthcare systems for many years. National efforts have been done to improve the overall outcomes during the last decades. Despite this, the mortality rates one year after hip fracture surgery are as high as 27% and have remained high the past 15 years. Patients that suffer from hip fractures are often elderly and have several comorbidities. The orthopaedic trauma and subsequent emergency surgery impose an activation of the sympathetic nervous system mediated through the release of catecholamines. This causes a hyper-adrenergic state, which can be harmful if prolonged, or if the patient already has a strain caused by comorbidities forgoing the injury, especially on the cardiovascular system. This gave rise to the thought of blocking the adrenergic receptor activation in hip fracture patients as an effort to reduce the mortality rates.

Papers I and II investigates the association between beta-blocker therapy and short-term mortality in hip fracture patients. In Paper I, (n=2443) patients operated in Orebro County between 2013 to 2017 were extracted from The National Quality Register for Hip Fractures (Rikshöft), to enable a more detailed review of the medical journals. The patients were divided into a betablocker cohort and a beta-blocker naive cohort. Results showed an 18% reduction in the risk of postoperative mortality within 90 days of surgery. In Paper II, all adults operated for traumatic hip fractures in Sweden between 2008 to 2017 were extracted from The National Quality Register for Hip Fractures and then cross-referenced with data from registers of The National Board of Health and Welfare. This resulted in a total of 134,915 patients eligible for analysis. The results demonstrated a 72% risk reduction in postoperative mortality within 30 days of surgery in the cohort with ongoing beta-blocker therapy.

Paper III explored if the effect seen in Paper I-II remains up to one year using the same database as Paper II. The results demonstrated that the association between beta-blocker therapy and reduction in the risk of mortality,extending up to one year postoperatively, with the main effect seen during the first postoperative period.

Paper IV investigates the interaction between the Revised Cardiac Risk Index and beta-blocker therapy related to 30-day post-operative mortality. This study concluded that all geriatric hip fracture patients could benefit from beta-blockers, but a more pronounced effect was seen in those with cardiac risk factors.