Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

Wijnen, Hugo H; Schmitz, Peter P; Es-Safraouy, Houda; Roovers, L.; Taekema, Diana G.; Susante, Job L C van

doi:10.1080/17453674.2021.1959155

Cited by 13 publications

(8 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although surgery increases the functional level and can contribute to pain relief, it requires hospitalization with the risk of postoperative complications; many patients cannot return home after hospital admission. An alternative is a nonoperative treatment, which is associated with a poor prognosis regarding survival [ 10 , 11 ]. The multicenter cohort FRAIL-HIP study recently compared nonoperative and operative treatment for frail institutionalized patients with limited life expectancy at 25 hospitals across the Netherlands [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS90)

Nijmeijer

Voorthuis²,

Groothuis-Oudshoorn³

et al. 2023

Osteoporos Int

View full text Add to dashboard Cite

Summary The AHFS 90 was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS 90 has a good accuracy and in most risk categories a good calibration. In our study population, the AHFS 90 yielded a maximum prediction of early mortality of 64.5%. Purpose Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS 90 ). Methods Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS 90 , which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks. Results One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS 90 includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS 90 had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS 90 overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS 90 had a maximal prediction of early mortality of 64.5% in this study population. Conclusion The AHFS 90 accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS 90 yielded a maximum prediction of early mortality of 64.5%. Supplementary information The online version contains supplementary material available at 10.1007/s00198-023-06696-9.

show abstract

Section: Introductionmentioning

confidence: 99%

The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS90)

Nijmeijer

Voorthuis²,

Groothuis-Oudshoorn³

et al. 2023

Osteoporos Int

View full text Add to dashboard Cite

show abstract

“…Patients with FNF treated nonoperatively had 30-day and 1-year mortality rates for NOM of 87% and 99%, respectively, when compared with 7% and 28%, respectively, for surgery [ 16 ]. Other studies have displayed wider mortality ranges; a meta-analysis reported 30-day and 1-year mortality rates between 5% and 65% (36% average) and 30% and 95% (60% average), respectively [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Girdlestone resection arthroplasty for femoral neck fractures has poorer outcomes than hemiarthroplasty in frail patients with increased risk for arthroplasty-related complications: a retrospective case study of 21 patients

Bellova,

Linne,

Postler

et al. 2024

ActaO

View full text Add to dashboard Cite

Background and purpose: Hemiarthroplasty (HA) is the usual treatment for displaced femoral neck fractures (FNF) in elderly patients. Patients may be unsuitable for HA due to secondary conditions such as systemic infections or severe neurological conditions, which is why Girdlestone resection arthroplasty (GRA) may be an option. We aimed to determine (1) patient survival in matched patient groups treated with either GRA or HA and (2) functional outcomes.Patients and methods: 21 patients treated with GRA for FNF in a German university hospital were retrospectively reviewed (2015–2019). After matching for age and comorbidities, a control group of 42 HA patients was established. Patient survival was determined by a Kaplan–Meier analysis. The mean follow-up (FU) was 1.5 (0–4.4) years. Function at FU was documented using the modified Harris Hip Score (mHHS) and the National Hip Fracture Database (NHFD) mobility score.Results: The 1-month-mortality was 19% in the GRA group and 12% in the HA group; the 1-year mortality was 71% and 49%, respectively (P = 0.01). The mHHS at FU was lower in the GRA group than in the HA group (22 [range 0–50] vs. 46 [11–80]). 82% of patients in the GRA group were bedridden post-surgery as opposed to 19% in the HA group.Conclusion: Patients with HA after FNF had higher survival and better functional outcomes when compared with GRA in matched patient groups. Considering this, GRA for FNF should be selected restrictively.

show abstract

“… 10 However, on an international scale, the rates of nonoperative treatment of hip fracture vary significantly, from 1% to 25%. 11 , 12 The decision to use nonoperative management for hip fracture, particularly among patients aged 80 to 104 years, may be highly challenging due to ethical, cultural, and legal issues, 13 , 14 and localization of the fracture may determine the preferred type of surgery. 15 , 16 These concerns should be considered within the context of hip fracture management, as hip fractures rank among the top 10 causes of disability globally, currently affecting 4.5 million people and are anticipated to increase to 21 million individuals within the next few decades.…”

Section: Introductionmentioning

confidence: 99%

Trends in Incidence of Hip Fracture and Hip Replacement in Denmark, 1996 to 2018

Jensen,

Pedersen,

Waldorff

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceThe past several decades have witnessed substantial changes in treatments that are particularly relevant for older patients.ObjectivesTo assess changes in national-level incidence rates of fracture- and musculoskeletal-related (ie, arthritis-related) hip replacement procedures for individuals aged 40 to 104 years over a 23-year period in Denmark.Design, Setting, and ParticipantsThis cohort study used national Danish health registers to include the Danish population aged 40 to 104 years from January 1, 1996, to December 31, 2018. Data were analyzed from May 31, 2022, to February 14, 2024.Main Outcomes and MeasuresAge- and period-specific incidence rates of hip fracture and hip replacement stratified on fracture-related vs arthritis-related indication.ResultsFrom 1996 to 2018, a total of 3 664 979 individuals were followed up for a mean (SD) of 14.6 (7.7) years, resulting in a follow-up time of 53 517 861 person-years and 158 982 (first) hip fractures, of which 42 825 involved fracture-related hip replacement procedures. A further 104 422 individuals underwent arthritis-related hip replacement. During the first 2 decades of the 21st century, hip fracture rates declined by 35% to 40% for individuals aged 70 to 104 years, and the proportion of the population undergoing fracture-related hip replacement increased by 50% to 70%, with modest variation across those aged 75 to 99 years. Rates of arthritis-related hip replacements peaked for individuals aged 75 to 79 years, but with the largest relative rate increase (75%-100%) occurring for those aged 80 to 94 years, primarily from 2001 to 2015, whereafter it remained nearly unchanged. The decline in rates of arthritis-related hip replacement after 75 to 79 years of age was gradual and did not suggest an upper age limit for access to arthritis-related hip replacement.Conclusions and RelevanceThe findings of this cohort study suggest that during the past several decades in Denmark, the incidence of hip fractures declined by 35% to 40% among patients aged 80 to 104 years, while the proportion receiving fracture-related hip replacement remained relatively constant after 75 years of age. During the first decades of the 21st century, arthritis-related hip replacement incidence increased by 50% to 100% among older patients and stabilized hereafter, with no apparent cutoff age for this type of procedure. These patterns indicate a positive overall trend with declining hip fracture incidence over the last decades in Denmark, and the observed hip replacement incidence suggests that age is currently not a major determining factor guiding this type of surgery.

show abstract

Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

Cited by 13 publications

References 17 publications

The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS90)

The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS90)

Girdlestone resection arthroplasty for femoral neck fractures has poorer outcomes than hemiarthroplasty in frail patients with increased risk for arthroplasty-related complications: a retrospective case study of 21 patients

Trends in Incidence of Hip Fracture and Hip Replacement in Denmark, 1996 to 2018

Contact Info

Product

Resources

About