C-reactive Protein Level, Admission to Intensive Care Unit, and High American Society of Anesthesiologists Score Affect Early and Late Postoperative Mortality in Geriatric Patients with Hip Fracture

Abstract

Purpose The main purpose of this study is to evaluate prognostic factors that affected the patients' early (<30 days) and late (six months, one year, and overall) postoperative mortality following hip fracture surgery. Materials and Methods This retrospective study included 515 patients older than 75 years old with surgically treated osteoporotic hip fracture. The demographic data, American Society of Anesthesiologists (ASA) classification, type of anesthesia, duration of hospital stay, and history of intensive care unit (ICU) stay were collected. An analysis of laboratory values was also performed to determine their relationship with mortality. The primary outcome was survival, determined as the time from the surgery to death or the end of the study. The patients were divided into four groups according to survival time: at the first month, six months, first year, and overall survival. An analysis of demographic and laboratory values was performed to determine their validity as prognostic factors for each group. Results Postoperative C-reactive protein (CRP) level showed an independent association with a poor survival at the first month. ASA classification, admission to the ICU, and preoperative CRP levels showed an independent association with a poor survival for the first six months. Preoperative CRP level showed an independent association with a poor survival for the first year. ASA classification, admission to the ICU, and the preoperative CRP levels showed an independent association with a poor overall survival. Conclusion CRP level, a high ASA classification, and postoperative ICU admission were related to poorer overall survival rate following hip fracture surgery in the elderly.

Orthogeriatric co-managements lower early mortality in long-lived elderly hip fracture: a post-hoc analysis of a prospective study

“…The lower early mortality amongst patients treated by orthogeriatric co-management care probably resulted from some different factors in some related literature [ 19 ]: First, the medical problems in long-lived patients are often of geriatric nature and are therefore better treated by geriatrist. Comorbidities like cerebrovascular or kidney disease and ICU admission were significant risk factors that increased mortality after osteoporotic hip fractures [ 33 , 34 ]. The orthogeriatric co-management care has greatly improved the level of comorbidity management, which can stabilize and improve the general condition of long-lived patients better and faster, avoid ICU admission, and then reduce the early mortality of long-lived elderly hip fracture patients.…”

The Nomogram Model and Factors for the Postoperative Mortality of Elderly Patients with Femoral Neck Fracture Undergoing Artificial Hip Arthroplasty: A Single‐Institution 6‐Year Experience

“…Perhaps due to the advancement of surgical techniques and the application of enhanced recovery after surgery (ERAS), these patients received better management for complications after surgery and enjoy a longer lifespan. Besides, the variable mortality reported in the literature may be associated with the heterogeneity of the population (i.e., age, co‐morbidities and national development) as well as postoperative care 21 . In Downey et al ., a retrospective analysis of local hip fracture cases from 36 different countries, the 1‐year mortality of patients was revealed as 2.4%–34.8% after a surgery for hip fractures 22 .…”

“…Besides, the variable mortality reported in the literature may be associated with the heterogeneity of the population (i.e., age, co-morbidities and national development) as well as postoperative care. 21 In Downey et al, a retrospective analysis of local hip fracture cases from 36 different countries, the 1-year mortality of patients was revealed as 2.4%-34.8% after a surgery for hip fractures. 22 Another study demonstrated that the 5-year death rate was 21.1% in 221 patients (>70 years) with hip fractures who underwent selective surgery.…”

Is a guideline required to predict the intensive care unit need of patients over 65 years of age during the preoperative period? A comparison of the American Society of Anesthesiologists, lung ultrasound score, Charlson age-added comorbidity index, surgical outcome risk tool indexes

“…Identifying comorbidities using a score helps to understand the overall medical condition of the patient. [ 31 ] Kilic et al searched the existence of a comorbidity in their study and found that the ICU admission rate was 40.59% in the patient group without any comorbidity, whereas the ICU admission rate was found as 77.78% in the group with two comorbidities. [ 6 ] Accordingly, the increase of comorbidities caused a significant increase in the ICU admission rate postoperatively.…”