Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment

Abstract

Background: The aging of the Chinese population is expected to lead to an increase in nonagenarians and centenarians. The mortality rate in nonagenarian hip fracture patients is equivalent to the mortality rate in the average population at 5 years after injury. It is imperative to evaluate 5-year mortality in this small but very challenging subgroup of patients to optimize patient management. The primary purpose of the current retrospective study was to compare five-year survival in patients aged over 90 years who received arthroplasty or nonoperative treatment for femoral neck fracture during a 16-year period. Methods: From January 1998 to December 2014, all consecutive nonagenarian and centenarian patients with femoral neck fracture admitted to our hospital were included in the evaluation. The primary outcome was defined as thirty-day, 1-year, 3-year, and 5-year mortality after injury. Survival analysis was performed with the Kaplan-Meier method. Using the log-rank test, stratified analyses were performed to compare differences in the overall cumulative mortality and mortality at three time points (1 year, 3 years, and 5 years) after injury and differences in survival distributions. Results: Over the 16-year study period, the arthroplasty group and the nonoperative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group was significantly higher than that of the nonoperative treatment group (p = 0.002). The survival time of the arthroplasty group was significantly higher than that of the nonoperative treatment group (median (P 75-P 25) = 53 (59) versus median (P 75-P 25) = 22 (52), p = 0.001). The mortality differences, except for 30-day mortality, at five time points (1, 2, 3, 4, and 5 years) between the nonoperative group and arthroplasty group were significant. The stratified analyses of overall cumulative mortality and mortality at three time points (1, 3, and 5 years) after injury demonstrated that the nonoperative treatment group had significantly higher cumulative mortality than the arthroplasty group. Conclusions: Our study demonstrates that arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. It can be expected that nearly half of patients will survive more than 5 years after surgery.

Surgical intervention may provides better outcomes for hip fracture in nonagenarian patients: A retrospective observational study

“…In our study, the 30-day mortality rates in the OP group are not inferior to those of previous studies on short-term mortality after surgery for hip fracture (1.7 % versus a range from 5.5 to 9.6 %) [ 9 , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ], and are significantly superior to those of the non-OP group (9.4 %). The estimated median survival times in the OP and non-OP groups were 57.4 and 24.3 months, respectively.…”

“…Liu et al performed a single center retrospective study for nonagenarian patients with femoral neck fracture and examined 53 operative patients versus 33 non-operative patients [ 31 ]. The survival time of the operative group was significantly higher than that of the nonoperative group (median: 53 months vs median: 22 months, p = 0.001).…”

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study

“…Surgeons and patients are often hesitant to proceed with surgery due to concerns over advanced age and pre-existing comorbidities that may lead to postoperative complications and mortality 9 , 10 . While certain experts 11 , 12 particularly regarding the survival results, have indicated advantages, there is concern 13 – 17 among certain research that high proportion of complication rates after surgery were observed whether they had been treated surgically or conservatively. Due to multiple comorbidities, leaving hip fractures untreated can result in 1-year mortality rates of over 60% for nonagenarians and centenarians, as well as other adverse outcomes including longer length of hospital stay (LOS), frequent readmissions, and increased rates of mortality and complications 18 , 19 .…”

Prevalence and correlative factors of hyperhomocysteinemia in elderly patients with femoral neck fracture: A cross‐sectional study

“…On the contrary, the treatment effect of FNF does not only depend on the ideal surgical option, but also on the patient's preoperative medical conditions and postoperative rehabilitation. Elderly patients with FNF usually have more and varied comorbidities 4,5 . A recent study indicated that comorbidity is the best predictor of mortality and mobility after hip fracture, after taking into account age, gender, fracture pattern, surgical delay, previous fracture, and comorbidity 6 .…”

“…Elderly patients with FNF usually have more and varied comorbidities. 4,5 A recent study indicated that comorbidity is the best predictor of mortality and mobility after hip fracture, after taking into account age, gender, fracture pattern, surgical delay, previous fracture, and comorbidity. 6 Besides, it has been well acknowledged that modifiable risk factors (MRFs) such as obesity, diabetes, tobacco use, anemia, low serum albumin, and poor dentition should be addressed prior to arthroplasty to reduce the incidence of postoperative complications.…”