Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures

Abstract

BackgroundThe purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality.MethodsThirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery.ResultsDeyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036).ConclusionsNonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.

Study on factors affecting mortality in nonagenarian patients in orthopaedic surgery

“…A recent study investigating factors affecting mortality in patients 90 years of age has found higher hazard ratios for mortality in patients with congestive heart failure and chronic obstructive pulmonary disease. 8 differs from this conclusion in this study. In this study, author found that the co-morbidity in the preoperative period was not effective on mortality rates.…”

“…In a recent study by Aschraf et al, they examined hip fractures in patients 90 years of age and older and gave similar mortality rates as the results (10.3% in hospital, 20.5% in 3 months and 35.9% in 1 year). 8 In this study, author found in-hospital mortality rate as 8.4% (n:7), 3month mortality rate as 18.1% (n:15), and 1-year mortality as 25.3% (n:21). In a study conducted by Lin et al, they found a mortality rate of 9.9%, which is similar to the in-hospital mortality rate in this study.…”

“…9 The different studies conducted on nonagenarian patients in the literature provide mortality rates within the range of 5.0%-10.0%, although varying depending on the patient population and working method. 8,10,11 In general, author think that the small differences between studies are not only due to hip fracture, but also other fracture groups that author included in the study.…”

“…However, surgical procedures in these patient groups generally give positive results. 8,12,13 Author think that the post-operative acute complications are the most important factors affecting the mortality of the patient and hence, optimal conditions and treatment should be provided to this patient group pre and post operation which would decrease the mortality rates in nonagenarian patients. Not only does it prevent mortality, it also supports early recovery, physical therapy, and early leave from the hospital.…”

Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

“…The presence of several comorbidities shown to be associated with poor outcomes in patients with hip fracture were adjudicated from electronic patient charts: dementia, 1,3,9,12,16,17 congestive heart failure (CHF), 26,27 chronic kidney disease (CKD), [28][29][30] and depression. 31 Each condition was recognized as present if cited in the patient's problem lists or physician notes.…”