Factors associated with mortality in older patients sustaining pelvic or acetabular fractures

Abstract

Introduction This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures. Materials and methods A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72 h and after 72 h. Kaplan–Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models. Results Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery (fracture fixation within or greater than 72 h), there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72 h were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index (CCI) and pre-op mobility status were associated with statistically significant differences in overall mortality. The same factors were associated with a significantly increased hazard of death in the multivariate Cox proportional hazards model. Patient gender, mechanism of injury, Injury Severity Score (ISS) > 15 and head injury were not significant predictors of mortality. Conclusion Surgical intervention within 72 h of injury did not result in decreased mortality in older patients with PA fractures. The 1-year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach between orthogeriatric and expert PA surgeons for these patients.

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations

“…Central to the ambiguity is the fact that there is not established definition for "early" fixation in the literature, as the range has varied from < 24 h to 15 days from injury [9,10]. More recent literature favors earlier surgical treatment [11][12][13] (Table 1.) Studies demonstrate early fixation can reduce morbidity in unstable PAF patients.…”

“…Enninghorst et al further concluded that ORIF of unstable pelvic ring fractures is safe within 6 h. Ding et al reviewed 791 acetabular fractures and found that increased time to fixation was associated with increased risk of infection with incidence as high as 40% with > 10 days of delay, compared to 15% for > 2 days of delay [15]. However, evidence suggests that there is no significant difference in 30-day, 60-day and 1-year mortality rates between geriatric PAF patients operated on within < 72 h compared to those operated on > 72 h [12,13] Furthermore, delays in surgical fixation have been shown to significantly reduce the quality of fracture reduction [16,17]. Using logistic regression analysis, Dailey et al showed that each day without operative intervention decreased the odds of anatomic reduction by 12% [17].…”

“…In their retrospective cohort of 650 acetabular fracture patients, Dailey et al found that patients reduced within 3 days vs 4.5 days vs 7 days had good (displacement </= 1 mm), imperfect (2-3 mm) and poor (> 3 mm) anatomic reductions, respectively [17]. Good anatomic reduction, coupled with findings of equivalent mortality and lower infection incidence has led several to conclude that early reduction is advised in PAF surgery [12,15,17].…”

Trends and treatments of pelvic and acetabular fractures in Taiwan: facing an aging society

“…Pelvic or acetabular fractures are rare injuries compared to fractures in other regions of the body, representing only about 3–8% of all fracture cases and associated with a high mortality rate of about 4–28% [ 1 ]. Pelvic fractures are one of the main results of low energy trauma such as falls, particularly in older adults.…”

For Surgically Treated Geriatric Acetabular Fractures, Longer Duration between Admission and Surgery Is Associated with an Increase in Post-operative Complications: A Study Using the National Trauma Data Bank

“…Level of evidence: Prognostic Level III F ractures of the acetabulum (AO/OTA 62A-C) in the elderly are associated with prolonged hospital stays, perioperative complications, 30-day mortality of between two and seven percent, and 1-year mortality rates of between and eight and 20%. [1][2][3][4][5] Treatment can be nonsurgical or surgical. Surgical treatment options include open reduction and internal fixation (ORIF), closed reduction and percutaneous fixation, total hip arthroplasty (THA), and combined ORIF-THA.…”