Research Abstract: Free Paper - Poster Presentation Only Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

Chronic Obstructive Pulmonary Disease (COPD) in Elderly Patients with Osteoporotic Hip Fracture (HF) (#149)

Siti Nur Fariza Binti Nordin 1 2 , Wichat Srikusalanukul 3 , Alex Fisher 2 3 4
  1. The Canberra Hospital, Phillip, ACT, Australia
  2. Geriatric Department, The Canberra Hospital, Canberra, ACT, Australia
  3. Australia National University Medical School, Canberra, ACT, Australia
  4. Orthopaedic Surgery , The Canberra Hospital, Canberra, ACT, Australia
Background:  We aimed to determine in HF patients the prevalence of COPD and its impact on outcomes.   Methods: Clinical and laboratory parameters, medication used, outcomes and readmission rates (within 6 months) have been analysed in 3677 HF patients (mean age 82.7±8.27 years, 74.8% females) including 559 [patients] with COPD.   Results: The prevalence of COPD among HF patients was 2.3-fold higher than in the general Australian population (15.1% vs. 6.6%). The COPD group compared to the rest of the cohort had a higher proportion of males (32.7% vs. 23.9%), subjects <80 years of age (35.4% vs. 29.5%), with coronary artery disease (CAD, 36.7% vs. 25.6%), myocardial infarction (10.4% vs.7.3%), hyperparathyroidism (>6.8 pmol/L: 52.6% vs. 48.0%), smokers (36.8% vs. 14.2), and alcohol over-users (7.9% vs. 3.7%). Post-operatively COPD patients demonstrated a significantly higher incidence of an inflammatory response (CRP >150 mg/L: 64.8% vs. 58.6%), troponin I rise (9.3% vs 6.4%), prolonged length of stay (30.1% vs. 24.6%), and deaths (7.7% vs. 4.7%). Independent predictors of hospital mortality were pre-operative CAD (OR 2.0), b-blocker use (OR 2.4), lymphocyte/monocyte ratio <1.1 (OR 2.72), red blood cell distribution>14.5% (OR 2.6) and postoperative troponin I rise (OR 4.5). Prolonged hospital stay was independently predicted by CAD (OR 1.6), vitamin D deficiency (OR 2.1), and hyperparathyroidism (OR 1.5). Only 17.4% of COPD patients received osteoporotic treatment pre-HF. Unplanned medical readmissions occurred in 70 (13.6%) patients, the risk was higher in subjects with CAD (50% vs. 33.8%), CKD (48.6 vs. 34.3%), postoperative myocardial injury (51.6% vs. 35.5%) and nursing home residents (41.4% vs. 29.6%). [In all abovementioned comparisons p<0.05].   Conclusions: In HF patients, COPD is prevalent, has a specific clinical profile, associated with poor hospital outcomes and high readmission rate; more than 80% of COPD patients did not receive preventive osteoporotic therapy pre-HF. There is an urgent need to optimise management of bone status in COPD.