Postoperative risk profile in elderly hip fracture patients undergoing chronic hemodialysis based on a nationwide database investigation

Hip fractures in elderly dialysis patients are associated with increased postoperative complications and mortality, but large-scale analyses remain limited. This retrospective cohort study utilized Japan's nationwide Diagnosis Procedure Combination database (2016-2022). After applying 1:1 propensity score matching, 9,601 chronic hemodialysis patients were compared with 9,601 non-dialysis patients for postoperative outcomes, including venous thromboembolism (VTE), cognitive dysfunction, and in-hospital mortality. The study cohort included only patients receiving chronic maintenance hemodialysis; peritoneal dialysis patients were not included. Statistical significance was defined as a p < 0.001. The in-hospital mortality rate was 5.2% in dialysis patients versus 1.7% in non-dialysis patients. Thirty-day postoperative survival was 99.2% in non-dialysis patients and 97.5% in dialysis patients. Dialysis patients had higher odds of postoperative cognitive dysfunction (OR: 1.944; 95% CI: 1.515-2.495, p < 0.0001) and in-hospital mortality (OR: 3.288; 95% CI: 2.743-3.941, p < 0.0001). The incidence of VTE was lower among dialysis patients. Male sex, older age, and lower BMI were also independent risk factors for mortality. Dialysis is associated with markedly worse outcomes following hip fracture surgery. Comprehensive perioperative management and preventive strategies are essential to improve prognosis in this high-risk population.