Mortality, readmission, and reoperation after hip fracture in nonagenarians

Lin, Chien Fu Jeff; Liang, Wen Miin

doi:10.1186/s12891-017-1493-5

Cited by 69 publications

(66 citation statements)

References 54 publications

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“…The increased mortality is significant within the first year after the fracture and extends beyond 10 years. The high mortality in patients with hip fractured is associated with many factors such as age, gender, co‐morbidity disease, fracture type, surgery type, the skills of the surgeons, and the medical care systems. The risk of post‐fracture mortality is also significantly higher for persons who have a subsequent fracture and do not take anti‐osteoporosis pharmacologic therapy following the fracture.…”

Section: Introductionmentioning

confidence: 99%

Anti‐Osteoporosis Medications Associated with Decreased Mortality after Hip Fracture

Wang

Zhuang

et al. 2019

Orthopaedic Surgery

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ObjectiveTo study the effect of anti‐osteoporosis therapies on mortality after hip fracture.MethodsThis retrospective study was carried out in the Second Affiliated Hospital of Fujian Medical University and enrolled 690 patients 50 years of age and older who were admitted with hip fractures between 2010 and 2015. The patients were followed in 2017: 690 patients aged was from 50 to 103 years. There were 456 women and 234 men. There were 335 patients with fractures of the femoral neck and 355 patients with intertrochanteric fractures of the femur. There were 444 (64.35%) patients who also had internal diseases. The Charlson comorbidity index was 0–6. The anti‐osteoporosis medications were classified into no anti‐osteoporosis medication, calcium + vitamin D supplementations, non‐bisphosphonate medication, and bisphosphonate medication. The physicians followed the patients or family members by personal visit and telephone. Multivariable Cox regression analyses were done with known risk factors for mortality of hip fracture, such as gender, age, number of combined internal diseases, fracture type, place of residence, and Charlson comorbidity index, to show which anti‐osteoporosis medications had significant effects on mortality after adjustment for these variables.ResultsOut of 690 patients with hip fractures, 149 patients received no anti‐osteoporosis medication, 63 patients received calcium +vitamin D supplementations, 398 patients received non‐bisphosphonate medication, and 80 patients received bisphosphonate medication. The patients were followed between 7 months and 52 months, with the average of 28.53 ± 9.75 months. A total of 166 patients died during the follow‐up period. Of 166 deaths, 43 occurred within 3 months, 65 within 6 months, and 99 within 1 year after the hip fracture. In this study, fracture type, place of residence, and Charlson comorbidity index were not associated with the mortality, and the male gender, age > 75 years, and ≥ 2 combined internal diseases were the independent factors for deaths post‐hip fracture. The cumulative mortality was 36.24% in the patients receiving no anti‐osteoporosis medication. The hazard ratio for mortality after hip fracture with bisphosphonate medication, non‐bisphosphonate medication, and calcium/vitamin D supplementation was 0.355 (95% CI, 0.194–0.648), 0.492 (95% CI, 0.347–0.699) and 0.616 (95% CI, 0.341–1.114), respectively, as compared with no anti‐osteoporosis group. Bisphosphonate and non‐bisphosphonate medications for osteoporosis were significantly associated with the reduction of cumulative mortality post‐hip fracture (P < 0.01).ConclusionsBisphosphonate and non‐bisphosphonate medications for osteoporosis were significantly associated with decreased mortality after fragility hip fracture.

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Section: Introductionmentioning

confidence: 99%

Anti‐Osteoporosis Medications Associated with Decreased Mortality after Hip Fracture

Wang

Zhuang

et al. 2019

Orthopaedic Surgery

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“…The total estimated number of hip fracture in Asian countries will increase from 1.12 million in 2018 to 2.56 million in 2050 [28]. Hip fractures are related to increased morbidity and adverse clinical outcomes during hospitalization and discharge are common and costly occurrences [29]. It is logical to perform surgery as early as possible(Best within 48 hours after hip fracture) in order to avoid these complications, especially to reduce the risk of VTE.…”

Section: Discussionmentioning

confidence: 99%

Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

Feng

Yuan

et al. 2020

Preprint

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Background This study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, whether transfusion, preoperative hospitalization, postoperative hospitalization, cardiac function, electrocardiograph, lower limb venous ultrasonography and hospitalization time. Results In these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P<0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026-0.799, P=0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023-1.259, P=0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

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“…However, recent studies demonstrated that the mortality rates of nonagenarian hip fracture patients would return to an equivalent mortality risk to the average population at five years after injury [9,[12][13][14][15][16]. Furthermore, less than 5% of patients can survive for more than ten years [16]. Consequently, the five-year survival rate can be considered as a reliable parameter to reflect the long-term outcomes of patients in the extremely elderly suffered hip fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there is no consensus of definition about the long-term survival for hip fracture patients over ninety. There are few articles discussed the five-year survival of the nonagenarians [9,[16][17].…”

Section: Introductionmentioning

confidence: 99%

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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, readmission, and reoperation after hip fracture in nonagenarians

Cited by 69 publications

References 54 publications

Anti‐Osteoporosis Medications Associated with Decreased Mortality after Hip Fracture

Anti‐Osteoporosis Medications Associated with Decreased Mortality after Hip Fracture

Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

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

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