Assessment of Mortality Risk in Elderly Patients After Proximal Femoral Fracture

Abstract

Mortality after hip fracture is a major problem in the Western world, but its mechanisms remain uncertain. This study assessed the 2-year mortality rate after hip fracture in elderly patients by including hospital factors (eg, intervention type, surgical delay), underlying health conditions, and, for a subset, lifestyle factors (eg, body mass index, smoking, alcohol). A total of 828 patients (183 men) 70 to 99 years old experiencing a hip fracture in 2009 in the province of Varese were included in the study. The risk factors for death were assessed through Kaplan-Meier analysis and Cox proportional hazards analysis. Hip fracture incidence per 1000 persons was higher in women (8.4 vs 3.7 in men) and in elderly patients (12.4 for 85-99 years vs 4.4 for 70-84 years). The mortality rate after 1, 6, 12, and 24 months was 4.7%, 16%, 20.7%, and 30.4%, respectively. For the province of Varese, sex (hazard ratio, 0.39 for women), age group (hazard ratio, 2.2 for 85-99 years), and Charlson Comorbidity Index score (hazard ratio, 2.06 for score greater than 1) were found to be statistically significant. The 2-year mortality rate in hip fractures is associated with sex, age, and comorbidities. Male sex, age older than 85 years, and Charlson Comorbidity Index score greater than 1 are associated with a higher risk. Surgical delay was significant in the Kaplan-Meier survival time analysis but not in the Cox hazard analysis, suggesting that early surgery reduces risk in patients with numerous comorbidities.

Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study

“…Accordingly, it has been demonstrated that both comorbidity and cognitive dysfunction are associated with a higher risk of surgical elderly patients 42. 43 Moreover, we included patients with different types of surgery, and therefore, our results might have a higher generalizability than those of studies performed in patients undergoing a single intervention.…”

The fate of proximal femoral fractures in the 10th decade of life: An analysis of 117 consecutive patients

“…The 30-day mortality following femoral fractures in elderly patients (with a mean age of 80 years) is less than 10% [11,13], and the 1-year mortality is 15-30% [5,6,11].…”

“…Apart from these cases, standard therapy is dependent on the type of fracture and includes osteosynthesis using dynamic hip screws (DHS), intramedullary nails (e.g., PFN), or alloarthroplasty [2][3][4]. There is a large body of evidence from studies that consistently show high morbidity and mortality in association with this injury, mainly in elderly patients [5,6].…”

Universal Postoperative Hip Instruction Protocol for Rehabilitation in Rural Skilled Nursing Facilities

“…The presence of comorbidities among the elderly before surgery increases the incidence for developing postoperative complications that contribute to mortality ( Meessen et al, 2014 ). The development of certain postoperative complications, such as pneumonia and congestive heart failure, can nearly double an elderly patient's risk for mortality ( Hamlet et al, 1997 ).…”