{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T13:50:03Z","timestamp":1778939403833,"version":"3.51.4"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Among older patients undergoing hip fracture surgery, previous studies have shown a seasonal variation of in\u2010hospital surgical complications. However, little is known about seasonal effects on mortality and systemic complications after hip fracture surgery. In the present study, we evaluated whether mortality and in\u2010hospital systemic complications are influenced by seasonal differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled patients from a nationwide database who underwent hip fracture surgery between 2010 and 2018. The primary outcome was in\u2010hospital mortality. The secondary outcomes were in\u2010hospital systemic complications. The association between the seasonality and in\u2010hospital outcomes was investigated using multivariable Cox, logistic regression and causal mediation analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With 425\u2009856 patients (mean age 83.5\u2009years; 79% women), overall in\u2010hospital mortality was 5324 (1.2%). Fall and winter were associated with a higher mortality than spring (hazard ratio [HR] 1.16; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001; HR 1.14; <jats:italic>P<\/jats:italic> = 0.001, respectively). Across all the seasons, there were 36\u2009834 overall systemic complications (8.6%), with respiratory infection being the most frequent (18\u2009637 [4.4%]). Among these complications, only respiratory infection showed seasonal variation, with a higher prevalence in fall and winter. The mediated effect of respiratory infection on mortality was significantly higher in fall and winter compared with spring (fall, HR 1.06, proportion mediated 36.7%; winter, HR 1.14, proportion mediated 55.0%; all <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found a significantly higher mortality in fall and winter after hip fracture surgery. Specifically, in winter, the increased in\u2010hospital death was largely attributed to the increased incidence of respiratory infection. <jats:bold>Geriatr Gerontol Int 2021; 21: 398\u2013403<\/jats:bold>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ggi.14153","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T04:57:24Z","timestamp":1616734644000},"page":"398-403","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Seasonality of mortality and in\u2010hospital complications in hip fracture surgery: Retrospective cohort research using a nationwide inpatient database"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6224-5519","authenticated-orcid":false,"given":"Takahisa","family":"Ogawa","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Tokyo Medical and Dental University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3511-9020","authenticated-orcid":false,"given":"Toshitaka","family":"Yoshii","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Tokyo Medical and Dental University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaya","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shingo","family":"Morishita","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Tokyo Medical and Dental University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1894-0290","authenticated-orcid":false,"given":"Kiyohide","family":"Fushimi","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Informatics Tokyo Medical and Dental University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeo","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Global Health Promotion Tokyo Medical and Dental University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Okawa","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Tokyo Medical and Dental University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1462"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jos.2017.06.003"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-016-3650-3"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1611090"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38643.663843.55"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0162097"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-009-1087-7"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001980170116"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.1997.12.1.24"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2008.05.009"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.11.023"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-009-0438-7"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2020.02.088"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-010-1485-x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/2151458516687810"},{"key":"e_1_2_7_17_1","first-page":"32","article-title":"International statistical classification of diseases and related health problems. 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