Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

Abstract

Introduction:The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications.Methods:A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital.Results:We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection.Conclusion:Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

Serum miR-146a and miR-150 as Potential New Biomarkers for Hip Fracture-Induced Acute Lung Injury

“…More and more researches have shown that elderly hip fracture induced systemic inflammatory response and ALI, which increased the incidence of pulmonary infection complications and mortality in the elderly patients [ 2 , 5 , 6 , 33 , 34 ]. Although many measures have been taken to deal with it, such as perioperative respiratory assessment and management, surgical technique amendment, and internal fixation instrument improvement, pulmonary infection rates still remain high in clinic; it is still the main cause of death in the elderly fracture patients [ 35 – 37 ]. As the important cause of lung infection complications, systemic inflammatory response and ALI induced by the elderly hip fracture have attracted more and more attention.…”

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

“…This may be due to the higher baseline degree of cognitive impairment and dependency or the higher degree of in-hospital complications in this age group. 9 , 11 , 12 …”

“… 9 Discrepancies have also been published regarding short and long-term outcomes. 6–8 , 11 , 12 A recent study including more than 4000 centenarians with hip fracture focused exclusively on complications during hospitalization, but did not include outcomes related to mortality or functional status in the first month after the fracture. 10 …”

Clinical Characteristics and Mortality of Old and Very Old Patients Hospitalized for Hip Fracture or Acute Medical Conditions

“…This is at variance to a common notion that older individuals undergoing surgery for hip fractures are at increased risk of death. Previous studies did not include a comparator group (11)(12)(13), or used incompatible control groups, such as those comprising younger patients (9,10,14). Some studies also compared mortality with standardised mortality of the general population (22,23).…”

“…There is an increasing interest in the impact of hip fractures on an ageing population of patients, particularly those older than 90 years of age, and the implications for improving care with disability, survival and consequences for health economics (9)(10)(11)(12)(13). Hitherto, results from previous studies have been limited due to the smaller number of very old patients, so that these studies accumulated data from different centres where management procedures may differ (13).…”