Outcome Following Surgery for Proximal FemurFractures in Centenarians

Abstract

PurposeThe Heart of England Foundation Trust has a catchment area of 1.5 million and admits more than one thousand patients with a proximal femur fracture annually. In an aging population, many of these are centenarians. In England and Wales in 2012, there were 12320 centenarians. Given the poor outcomes reported in this patient group further study is important. We report one of the largest known series assessing outcomes and examining the implications for resource allocation. MethodsThirty-two centenarians with a proximal femur fracture who were admitted between January 2000 and April 2012 were compared with a group of 33 patients aged between 60-95 years. Patient outcomes were measured in terms of mortality, mobility, and post operative residential status. ResultsThe average age amongst centenarians was 101.71 years, with a female preponderance in both groups. Three quarters of younger patients lived at home compared with 40.6% aged ≥100 years. As expected, younger patients had better pre-morbid mobility, with 42.42% walking independently compared with 9.37% of centenarians. The distribution of fracture types was similar in both groups.Centenarians' stay was 10.1 days greater than younger patients, whilst in-hospital mortality was 18.8% compared with 34.4% (younger vs centenarians). Thirty day mortality was almost double in centenarians whilst 120 day mortality, at 62.5% compared with 21.2% in the younger patients was statistically significant.Upon discharge, two thirds of younger patients returned home, compared with only 15.6% of centenarians. Of the younger patients, 42.4% regained pre-fracture mobility compared with 15.6% of centenarians. None of the younger patients were unable to walk post-operatively compared with more than 33% of centenarians. ConclusionsOur findings support previous studies which show that centenarians have poor outcomes with a 120 day mortality exceeding 50%. Such patients require prolonged hospitalisation and social care support. It emphasises the requirement for preventative resource allocation to an aging population.