DOI: 10.47582/jompac.2010464 ISSN: 2717-7505

Femoral arterial calcification severity on admission pelvic radiographs and 90-day mortality after hip fracture

Fırat Doğruöz, Safa Arıkan, Kaan Sarıtaş, Serkan Gürcan, Özkan Köse
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Aims: To determine whether the severity of femoral arterial calcification (FAC) visible on routine admission pelvic radiographs is associated with 90-day all-cause mortality after surgically treated hip fracture. Methods: This retrospective single-center cohort study included 371 patients aged 60 years or older who underwent surgery for a femoral neck or intertrochanteric fracture between September 12, 2021, and March 29, 2026. FAC was classified on admission radiographs as grade 0 (absent), grade I (mild), grade II (moderate), or grade III (severe). The primary outcome was all-cause mortality within 90 days of hospital admission. A single multivariable logistic regression model included age, gender, Charlson Comorbidity Index (CCI), fracture type, time from admission to surgery, and FAC grade. Kaplan-Meier curves were compared using the log-rank test. Results: The mean age was 80.8±8.2 years, and 219 patients (59.0%) were female. FAC was grade 0 in 48 patients (12.9%), grade I in 92 (24.8%), grade II in 107 (28.8%), and grade III in 124 (33.4%). Thirty-day and 90-day mortality occurred in 44 (11.9%) and 85 (22.9%) patients, respectively. Ninety-day mortality did not differ among FAC grades (20.8%, 23.9%, 25.2%, and 21.0%, respectively; p=0.859). In the multivariable model, older age (adjusted odds ratio [OR] 1.06 per year, 95% confidence interval [CI] 1.02-1.10; p=0.002) and higher CCI (adjusted OR 1.18 per point, 95% CI 1.03-1.36; p=0.018) were associated with increased mortality, whereas female gender was associated with lower mortality (adjusted OR 0.54, 95% CI 0.32-0.92; p=0.022). FAC grade was not independently associated with mortality (adjusted OR 0.87 per grade, 95% CI 0.67-1.11; p=0.264). Kaplan-Meier survival curves did not differ among grades (log-rank p=0.843). Conclusion: In this single-center cohort, increasing radiographic FAC severity was not associated with higher 90-day mortality and did not show a clear dose-response pattern. Established clinical factors, particularly age, gender, and comorbidity burden, were more informative predictors of early mortality than FAC grade. External validation of the proposed FAC grading system is required before broader conclusions regarding its prognostic utility can be drawn.

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