Hip Fracture in Nonagenarians: Characteristics and Factors Related to 30-Day Mortality in 1177 Patients

Mayordomo-Cava, Jennifer; Abásolo, Lydia; Montero-Fernández, Nuria; Ortiz-Alonso, Javier; Vidán-Astiz, Maite

doi:10.1016/j.arth.2019.12.044

Cited by 16 publications

(10 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nonagenarians with hip fractures are different from younger hip fracture patients. In one study, the group of nonagenarians with hip fracture was with more women patients, higher prevalence of heart disease, lower prevalence of COPD and diabetes than younger patients with hip fracture 7 . A recent study reported that patients older than 90 years with hip fractures had higher mortality rates per year than younger patients 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Baseline functional status was poorer among the nonagenarians. The prevalence of independent for transferring from bed to chair before the fracture varied between 50 and 70% depending on the different countries and districts 7 . In addition, medical complications after hip fracture, such as delirium, had been found more frequently in nonagenarian patients with hip fracture during their hospital stay 9 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture

Zhao

Sun²,

Zhang³

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Hip fractures in nonagenarians is one of the great challenges for patients of this age, the family and the larger society. The purpose of this study was to investigate the risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture. 199 Eligible patients were enrolled. Confusion Assessment Method (CAM) were used to identify the delirium. Logistic regressions were used to investigate the effect of 18 pre-existing conditions on postoperative delirium. Prognosis of postoperative delirium in nonagenarians with hip fracture were also be evaluated. The results indicated the following: (1) the prevalence of postoperative delirium among nonagenarians with hip fracture was 28.1% (56 of 199); (2) coexisting disease ≥ 4 (OR = 5.355, 95% CI = 1.394–9.074, P = 0.007), longer admission to operating time (OR = 1.514, 95% CI = 1.247–1.837, P = 0.000), and general anesthesia (OR = 2.086, 95% CI = 1.804–7.968, P = 0.032) were independent risk factors for postoperative delirium in nonagenarians with hip fracture; (3) nonagenarians with postoperative delirium had a predominantly high burden of perioperative complications, long length of stay, and postoperative mortality at 30 days follow-up and 1 year follow-up than the patients without postoperative delirium. The results could enable clinicians to improve outcome after operation in nonagenarians with hip fracture.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture

Zhao

Sun²,

Zhang³

et al. 2023

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Despite advances in medical and surgical treatments for geriatrics with hip fractures, postoperative mortality has increased with increasing age, especially in nonagenarians with significant comorbidity ( 6 , 7 ). Several studies have investigated the risk factors contributing to mortality in the extremely old patients ( 8 , 9 ), with the goal of helping clinicians and surgeons to reduce risk and improve outcomes. Nevertheless, risk factors related to 1-year mortality were rarely investigated in previous studies and few attempts have been made to quantify the contribution of established risk factors to postoperative mortality in nonagenarians with hip fracture.…”

Section: Introductionmentioning

confidence: 99%

A New Nomogram Model for Predicting 1-Year All-Cause Mortality After Hip Arthroplasty in Nonagenarians With Hip Fractures: A 20-Year Period Retrospective Cohort Study

Wang

Chong

et al. 2022

Front. Surg.

View full text Add to dashboard Cite

BackgroundChina has become an ageing society and as it continues to age, it will face an increasing number of hip fractures in nonagenarians. However, few preoperative assessment tools to determine the postoperative mortality risk in nonagenarians with hip fracture were available. The aim of this study was to identify all-cause mortality risk factors after hip arthroplasty in nonagenarians with hip fractures and to establish a new nomogram model to optimize the individualized hip arthroplasty in nonagenarians with hip fractures.MethodsWe retrospectively studied 246 consecutive nonagenarians diagnosed with hip fracture from August 2002 to February 2021 at our center. During the follow-up, 203 nonagenarians with a median age of 91.9 years treated with hip arthroplasty were included, of which 136 were females and 67 were males, and 43 nonagenarians were excluded (40 underwent internal fixation and 3 were lost to follow-up). The full cohort was randomly divided into training (50%) and validation (50%) sets. The potential predictive factors for 1-year all-cause mortality after hip arthroplasty were assessed by univariate and multivariate COX proportional hazards regression on the training set, and then, a new nomogram model was established and evaluated by concordance index (C-index) and calibration curves.ResultsAfter analyzing 44 perioperative variables including demographic characteristics, vital signs, surgical data, laboratory tests, we identified that age-adjusted Charlson Comorbidity Index (aCCI) (p = 0.042), American Society of Anesthesiologists (ASA) classification (p = 0.007), Urea (p = 0.028), serum Ca2+ (p = 0.011), postoperative hemoglobin (p = 0.024) were significant predictors for 1-year all-cause mortality after hip arthroplasty in the training set. The nomogram showed a robust discrimination, with a C-index of 0.71 (95%CIs, 0.68–0.78). The calibration curves for 1-year all-cause mortality showed optimal agreement between the probability as predicted by the nomogram and the actual probability in training and validation sets.ConclusionA novel nomogram model integrating 5 independent predictive variables were established and validated. It can effectively predict 1-year all-cause mortality after hip arthroplasty in nonagenarians with hip fracture and lead to a more optimized and rational therapeutic choice.

show abstract

“…Surgical osteosynthesis is considered the gold standard of care for hip fracture, with nearly all patients receiving operative management in Australia [ 4 ]. While some international literature has reported on the preoperative, surgical and anaesthetic factors affecting postoperative outcomes in nonagenarian patients [ 2 , 7 , 8 ], no comparative data exist in the Australian context. Moreover, the majority of existing data focus on preoperative factors affecting post-surgical outcomes, including time to surgery, patient comorbidity and advanced age [ 2 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…While some international literature has reported on the preoperative, surgical and anaesthetic factors affecting postoperative outcomes in nonagenarian patients [ 2 , 7 , 8 ], no comparative data exist in the Australian context. Moreover, the majority of existing data focus on preoperative factors affecting post-surgical outcomes, including time to surgery, patient comorbidity and advanced age [ 2 , 7 , 8 ]. Additionally, there remains a dearth of international data assessing the impact of complications and perioperative factors on short- and long-term mortality among nonagenarians.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing early and long-term survival following hip fracture among nonagenarians

et al. 2021

View full text Add to dashboard Cite

Background The outcomes of nonagenarian patients undergoing orthopaedic surgery are not well understood. We investigated the 30-day mortality after surgical treatment of unilateral hip fracture. The relationship between postoperative complications and mortality was evaluated. Methods We performed a single-centre retrospective cohort study of nonagenarian patients undergoing hip fracture surgery over a 6-year period. Postoperative complications were graded according to the Clavien–Dindo classification. Correlation analyses were performed to evaluate the relationship between mortality and pre-specified mortality risk predictors. Survival analyses were assessed using Cox proportional hazards regression modelling. Results The study included 537 patients. The 30-day mortality rate was 7.4%. The mortality rate over a median follow-up period of 30 months was 18.2%. Postoperative complications were observed in 459 (85.5%) patients. Both the number and severity of complications were related to mortality (p < 0.001). Compared to patients who survived, deceased patients were more frail (p = 0.034), were at higher ASA risk (p = 0.010) and were more likely to have preoperative congestive heart failure (p < 0.001). The adjusted hazard ratio for mortality according to the number of complications was 1.3 (95% CI 1.1, 1.5; p = 0.003). Up to 21 days from admission, any increase in complication severity was associated significantly greater mortality [adjusted hazard ratio: 3.0 (95% CI 2.4, 3.6; p < 0.001)]. Conclusion In a nonagenarian cohort of patients undergoing hip fracture surgery, 30-day mortality was 7.4%, but 30-month mortality rates approached one in five patients. Postoperative complications were independently associated with a higher mortality, particularly when occurring early.

show abstract

Hip Fracture in Nonagenarians: Characteristics and Factors Related to 30-Day Mortality in 1177 Patients

Cited by 16 publications

References 38 publications

Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture

Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture

A New Nomogram Model for Predicting 1-Year All-Cause Mortality After Hip Arthroplasty in Nonagenarians With Hip Fractures: A 20-Year Period Retrospective Cohort Study

Factors influencing early and long-term survival following hip fracture among nonagenarians

Contact Info

Product

Resources

About