Preprint · Jan 21, 2026

Association Between Statin Use and Postoperative Mortality in Older Patients with Hip Fractures

By Lee L, Chuang SH, Chang CH et al.

Purpose Hip fracture mortality remains persistently high despite surgical advances. Statins have demonstrated pleiotropic anti-inflammatory and antithrombotic effects, yet their peri-operative benefit remains controversial. The purpose of this study was to evaluate the association between pre-operative statin use and one-year mortality in older hip fracture patients, and to determine whether any survival benefit was accompanied by reductions in mechanistically related complications. Methods This retrospective cohort study utilized the TriNetX US Collaborative Network to identify patients aged 65–85 years undergoing hip fracture surgery between 2013 and 2024. Propensity score matching (1:1) was performed to balance baseline characteristics between chronic statin users and non-users (n = 5,708 per group). The primary outcome was one-year all-cause mortality. Secondary outcomes included stroke, cardiac arrest, venous thromboembolism (VTE), pneumonia and sepsis. Results Pre-operative statin use was associated with a significantly reduced risk of one-year mortality (HR 0.72; 95% CI 0.65–0.81; p < 0.001), evident as early as one month post-surgery. However, this immediate survival benefit was not accompanied by significant reductions in mechanistically relevant complications, including stroke, cardiac arrest, VTE, pneumonia or sepsis (all p > 0.05). Sensitivity analyses yielded consistent results. Conclusion The temporal dissociation between reduced mortality and unchanged complication rates suggests that the observed survival benefit likely reflects baseline systemic stability and the ’healthy user effect’ rather than direct acute pharmacological protection. While statins remain indicated for long-term cardiovascular prevention, our data do not support initiating statins solely to improve short-term peri-operative survival in this catabolic population.

doi.org/10.22541/au.176902044.40784229/v1Open accessInterventions