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β-adrenergic blockade is associated with a reduced risk of 90-day mortality after surgery for hip fractures
  1. Ahmad Mohammad Ismail1,2,
  2. Tomas Borg1,2,
  3. Gabriel Sjolin2,3,
  4. Arvid Pourlotfi2,3,
  5. Sebastian Holm1,
  6. Yang Cao4,
  7. Per Wretenberg1,2,
  8. Rebecka Ahl2,5,6,
  9. Shahin Mohseni7
  1. 1Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden
  2. 2School of Medical Sciences, Örebro University, Örebro, Sweden
  3. 3Department of Surgery, Örebro University Hospital, Örebro, Sweden
  4. 4Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
  5. 5Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
  6. 6Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
  7. 7Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden
  1. Correspondence to Dr Shahin Mohseni; mohsenishahin{at}


Background There is a significant postoperative mortality risk in patients subjected to surgery for hip fractures. Adrenergic hyperactivity induced by trauma and subsequent surgery is thought to be an important contributor. By downregulating the effect of circulating catecholamines the increased risk of postoperative mortality may be reduced. The aim of the current study is to assess the association between regular β-blocker therapy and postoperative mortality.

Methods This cohort study used the prospectively collected Swedish National Quality Registry for hip fractures to identify all patients over 40 years of age subjected to surgery for hip fractures between 2013 and 2017 in Örebro County, Sweden. Patients with ongoing β-blocker therapy at the time of surgery were allocated to the β-blocker-positive cohort. The primary outcome of interest was 90-day postoperative mortality. Risk factors for 90-day mortality were evaluated using Poisson regression analysis.

Results A total of 2443 patients were included in this cohort of whom 900 (36.8%) had ongoing β-blocker therapy before surgery. The β-blocker positive group was significantly older, less fit for surgery based on their American Society of Anesthesiologists classification and had a higher prevalence of comorbidities. A significant risk reduction in 90-day mortality was detected in patients receiving β-blockers (adjusted incidence rate ratio=0.82, 95% CI 0.68 to 0.98, p=0.03).

Conclusions β-blocker therapy is associated with a significant reduction in 90-day postoperative mortality after hip fracture surgery. Further investigation into this finding is warranted.

Level of evidence Therapeutic study, level III; prognostic study, level II.

  • femoral fractures
  • hip fractures
  • emergency treatment
  • mortality

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  • Presented at The abstract has been accepted for presentation in Orthopaedic Trauma Association (OTA) Annual Meeting in September 2020.

  • Contributors Study design: SM, AMI, TB, RA. Data collection: SM, AMI, AP, SH. Analysis and interpretation of data: SM, AMI, GS, YC, RA, TB, PW. Article draft: SM, AMI, RA, TB, PW. All authors have critically revised and accepted the submitted article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02094). The principles of the Declaration of Helsinki and Strengthening the Reporting of Observational Studies in Epidemiology guidelines were adhered too.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. According to the granted IRB the data are only to be accessed by the research team. However, upon reasonable request, the authors will seek extension from the IRB for the editorial board to have access to the data.

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