Mortality and its risk factors in nonagenarians after hip fractures

Kim, Jin Woo; Kim, Dong Hyun; Jang, Eui Chan; Lee, Yong Seuk; Koo, Kyung Hoi; Ha, Yong Chan

doi:10.1016/j.jos.2019.02.019

Cited by 23 publications

(23 citation statements)

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“…In this multicenter retrospective study of 327 nonagenarian individuals, Liu et al showed that the 1-year mortality after surgery was 11.6% [32]. Previous studies demonstrated that 1-year mortality in nonagenarian femoral neck patients varied from 23.3 to 47.6% [6,16,30,[33][34][35]. Although our 1-year mortality rate in the arthroplasty group was lower than those in the previously mentioned studies, it was similar to other studies [11,36].…”

Section: Discussionsupporting

confidence: 88%

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

Liu

Zhang

Zhao

2020

BMC Musculoskelet Disord

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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.

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Section: Discussionsupporting

confidence: 88%

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

Liu

Zhang

Zhao

2020

BMC Musculoskelet Disord

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“…Despite a shorter time to surgery to decrease further displacement and a reduction in subsequent complications when compared with BHA after preoperative optimization 27 , the time to MSF was 3.1 days in nondisplaced and 2.7 days in displaced FNF, which was longer than the 24 to 48 h recommended by previous studies 28 , 29 (Table 2 ). This might originate from the characteristics of the participating institutions (university hospitals) as a referral center, resulting in more time taken for referral and management of severe comorbidities.…”

Section: Discussionmentioning

confidence: 67%

Multiple screw fixation versus cementless bipolar hemiarthroplasty for femur neck fracture using a nationwide hip fracture registry

Kim

Park

Lee

et al. 2021

Sci Rep

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Cementless bipolar hemiarthroplasty (BHA) recently gained popularity as a treatment for femur neck fracture (FNF), but there have been few studies comparing this with multiple screw fixation (MSF) in the elderly population. The purpose of this study is to compare (1) surgery-related parameters, (2) reoperation rate as a local complication, (3) in-hospital systemic complication rate, and (4) mortality rate at 1 year after MSF and cementless BHA in patients with FNF using nationwide data. Six-hundred sixty-six hips (aged ≥ 50 years) extracted from nationwide Hip Fracture Registry were included in this study (133 MSF and 533 cementless BHA). One hundred fifty-six hips were divided into nondisplaced FNF (Group A) and 510 into displaced FNF (Group B). We evaluated (1) surgery-related parameters (anesthesia type, time to surgery, operation time, estimated blood loss and volume of postoperative transfusion), (2) the rate of and reasons for reoperation, (3) the rate and type of in-hospital systemic complications and (4) one-year mortality rate after surgery. In Group A, MSF showed shorter operation time (p = 0.004) and lower incidence of in-hospital systemic complications (p = 0.003). In Group B, cementless BHA demonstrated lower reoperation rate than MSF (p < 0.001). In both Group A and B, cementless BHA was associated with higher estimated blood loss than MSF (p < 0.001). Based on findings in our study, MSF might be a more favorable option for nondisplaced FNF, whereas cementless BHA might be a better one for displaced FNF in patients older than fifty. Nevertheless, our nationwide study also showed that numbers of cementless BHAs were being performed for nondisplaced FNF even in teaching hospitals.

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“…In this multicenter retrospective study of 327 nonagenarian individuals, Liu et al showed the 1-year mortality after surgery is 11.6% [32]. Previously studies demonstrated that the 1-year mortality for nonagenarian femoral neck patients varied range from 23.3% to 47.6% [6,16,30,[33][34][35]. Although our result of 1-year mortality of arthroplasty group was lower than previously mentioned studies, similar to other studies [11,[36][37][38], another possible explanation for the difference of mortality rate between this study and previous studies might be related to different demographics including age, distribution of gender, and comorbidity in each study.…”

Section: Discussionmentioning

confidence: 94%

Long-term survival of femoral neck fracture patients age over ninety: Arthroplasty compare with conservative treatment

Liu

Zhang

Zhao

2020

Preprint

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Background The aging of the China population is expected to lead to increasing of nonagenarian and centenarian.The mortality rates of nonagenarian hip fracture patients would return to an equivalent mortality risk to the normal population at five years after injury. It is imperative to evaluate the 5-year mortality for this small but very challenging subgroup patients in order to optimize patient management. The main purpose of the current retrospective study was to compare the five-year survival between arthroplasty treatment and conservative treatment of femoral neck fracture patients age over 90 years during the same 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 for evaluation. The primary outcome was defined as thirty-day mortality, 1-year, 3-year, and 5-year mortality after injury. Survival status analysis was performed by the Kaplan–Meier method for mortality. Using the log-rank test, the stratified analyses were performed to compare the difference of overall cumulative mortality and three-time points (1-year, 3-year, and 5-year) mortality after injury were performed to compare the difference of survival distributions.Results Over the 16-year study period, the arthroplasty group and the conservative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group is significantly higher than the conservative treatment group( p=0.002277). The survival time of the arthroplasty group is significantly higher than the conservative treatment group(Median(P75-P25)=53(59) versus Median(P75-P25)=22(52), p=0.001). The difference of five time points (1-year, 2-year, 3-year, 4-year, and 5-year) mortality between the conservative group and arthroplasty group is significant except for 30-day mortality.The stratified analyses of overall cumulative mortality and three-time points (1-year, 3-year, and 5-year) mortality after injury demonstrated that the arthroplasty group is significant higher than the conservative treatment group.Conclusions Our study demonstrate that, compared with conservative treatment, arthroplasty surgery is more likely to improve the long-term survival of femoral neck fracture patients over 90s. What can be expected is that nearly half of patients will survive more than five years after surgery.

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Mortality and its risk factors in nonagenarians after hip fractures

Cited by 23 publications

References 23 publications

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

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

Multiple screw fixation versus cementless bipolar hemiarthroplasty for femur neck fracture using a nationwide hip fracture registry

Long-term survival of femoral neck fracture patients age over ninety: Arthroplasty compare with conservative treatment

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