Gender differences in patients with hip fracture: A greater risk of morbidity and mortality in men

Objective: To determine gender-specific differences in prefracture status and postoperative outcome in elderly hip fracture patients who were ambulatory, community-dwelling, and cognitively intact prior to fracture. Design: Retrospective analysis of prospectively collected data. Setting: Urban orthopedic referral hospital. Patients: A total of 983 consecutive patients (206 males and 777 females) who sustained a nonpathologic hip fracture were followed for a minimum of 12 months. Intervention: Operative treatment of a proximal femur fracture. Main Outcome Measurements: postoperative medical complications, place of discharge, 1-year mortality, and postoperative recovery of ambulation, basic activities of daily living, and instrumental activities of daily living. Results: Men were more likely to be married or living with someone else, and they were more dependent in instrumental activities of daily living than women prior to hip fracture. Furthermore, men were sicker as evidenced by a higher American Society of Anesthesiologists rating of preoperative risk. Postoperatively, men were more likely to sustain a medical complication and had a higher mortality at 1 year compared to women. There were no statistically significant gender differences in patient age, fracture type, prefracture level of help, ambulation, or dependence in basic activities of daily living, place of discharge, and postoperative recovery of ambulation as well as basic and instrumental activities of daily living. Conclusions: Male gender was a risk factor for sustaining a postoperative complication as well as a higher mortality at 1 year post hip fracture.