In-Hospital Mortality following Proximal Femur Fractures in Elderly Population

Abstract

Context In India, hip fracture crude incidence above the age of 50 years was 129 per 100,000. Aims The aim of this study is to analyze the in-hospital mortality following proximal femur fractures in elderly Indian population. Methods and Material The study was done in Sri Ramachandra Medical Center, Chennai, India. Patient's records were retrospectively evaluated for a period of 3 years from January 1, 2015 to January 1, 2018. The inclusion criteria were patients both male and female aged more than 65 years admitted with the diagnosis of neck of femur or intertrochanteric or subtrochanteric fractures. The exclusion criteria were patients having any associated fracture or previous hip fracture history or diagnosed primary or secondary malignancies. To evaluate any surgical delay two groups were formed. After eliminating cases based on exclusion criteria, we had 270 patients for evaluation. Statistical Analysis Used The collected data were analyzed with IBM.SPSS statistics software 23.0 Version. To describe about the data descriptive statistics frequency analysis, percentage analysis were used for categorical variables and the mean and standard deviation (SD) were used for continuous variables. To find the significant difference between the bivariate samples, Student's t-test and analysis of variance (ANOVA) were used. The p-value of 0.05 is considered as significant level. Results We had a total of 24 mortalities with 15 males and 9 females. The in-hospital mortality of patients who underwent replacement surgeries for proximal femur fractures was 14 in our study. Sixteen of the in-hospital mortality patients had low Parker's mobility score. Twenty patients had mortality when surgery was delayed more than 48 hours. Conclusions In-hospital mortality in elderly patients having proximal femur fracture increases significantly if the patient was having low-preoperative mobility status, if surgery was delayed more than 48 hours, and if patient undergoes replacement surgeries.

Should the early surgery threshold be moved to 72 h in over-85 patients with hip fracture? A single-center retrospective evaluation on 941 patients

“…(continued) mortality rate, which is consistent to some other recent studies[38,39,54,[60][61][62][63][64]. General anesthesia was associated to a higher 30-day mortality rate.…”

Impact of Covid-19 on Mortality and Hospitalization in Older Adults With Hip Fracture

“…1,12 A possible justification for the increase in cases with unfavorable outcome and length of hospitalization in our reference center is based on the change in the care line of the institution that modified the flow of care and overloaded the care team, 16 a reality also experienced in other health centers. 14,15 Literature on the topic shows that the ideal time for surgical treatment of proximal femoral fractures should occur within 48 hours after the fracture episode, 17,18 to reduce the length of hospital stay and mortality. 19 Nevertheless, in this study we observed that the changes in orthopedic care imposed by the pandemic impacted the preoperative increase and hospital stay, similar to what was reported by Segarra et al 20 The pandemic period imposes several adaptations in hospital centers to improve the management of fractured patients during the pandemic that may have impacted the increase in hospitalization time, such as a reduction in the number of elective orthopedic surgeries, improvement in the perioperative management of older patients, deliberation of the appropriate time of surgery according to the risk and severity of COVID-19 and underlying medical condition, and use of universal pandemic containment precautions.…”

Management of Traumatology Patients During the Coronavirus (COVID-19) Pandemic: Experience in a Hub Trauma Hospital in Northern Italy

“…Despite COVID-19 outbreak, the before-48 h-treatment of these patients at our Institution is a bit lower than the national average reported in Italian hospitals before the pandemic. Nonetheless, the delay in treating proximal femur fractures in elderly patients is shown to have detrimental effects and the risk of mortality arises significantly [ 7 – 9 ]. Among our patients, one patient (5.26%) treated after 48 h died within the first post-operative week: this case had several comorbidities and was COVID-19 free.…”