One-Year Mortality After Acetabular Fractures in Elderly Patients Presenting to a Level-1 Trauma Center

Bible, Jesse E.; Wegner, Adam M.; McClure, D. J.; Kadakia, Rishin J.; Richards, Justin E.; Bauer, Jennifer M.; Mir, Hassan R.

doi:10.1097/bot.0b013e31829e801b

Cited by 37 publications

(26 citation statements)

References 13 publications

(14 reference statements)

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“…The average duration of hospital stay was long (14 days, SD 10 days), compared to other studies that state a median hospitalisation of 8 to 11 days [10,14,15].Operatively treated patients had a longer average hospitalisation time, which is consistent with the findings of one previous publication on this topic [15].…”

Section: Discussionsupporting

confidence: 87%

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

et al. 2020

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Background: Early operative treatment of acetabulum fractures in geriatric patients has been suggested to reduce pain and allow for earlier mobilization. The aim of this study was to determine mortality, complications and functional outcome after operative and non-operative treatment. Methods: Patients aged ≥60 years with operative treatment of low-energy fragility fracture of the acetabulum from 2009 to 2016 and a follow-up of at least 24 months were identified. The patients were contacted by phone and a modified Merle d'Aubigné score was obtained. If patients or their relatives were not available for follow-up, mortality data was assessed using a national social insurance database. Results: One hundred seventy-six patients (mean age 78, SD 10 years; 73 female) were available for analysis of mortality data. At final follow-up (68 months, SD 26, range, 24 to 129), 99/176 patients (56.3%) had deceased. Oneyear-mortality was 25.0% and 2-year mortality 35.8%. Type of treatment (non-operative vs. operative) did not affect mortality at 1 and 2 years (p = .65 and p = .10). Hospital-acquired infections were observed in 31/176 cases (17.6%), thromboembolic events and delirium in 6 patients (3.4%). In-hospital mortality was 5.7%. Patients who underwent operative treatment were more likely to have an in-hospital infection (p = .02) but less likely to sustain thromboembolic events (p = .03). The mean hospital stay was 14 days (SD 10 days, range, 1 to 66). Patients with operative treatment were longer hospitalized than patients with non-operative treatment (p < .001). The rate of secondary conversions to THA was 12.4%, this was not affected by initial treatment. The mean modified Merle d'Aubigné Score of those patients available for a final follow-up (n = 47; follow-up 56 months, SD 28, range, 24 to 115) was 14/18 points, SD 3 (range 7 to 18). Functional results at final follow-up between operatively and non-operatively treated patients were without difference. Conclusions: All-cause mortality and in-hospital complications are high among geriatric patients with low-energy fractures of the acetabulum even when treated operatively. Secondary conversion rates to THA are similar to those seen in younger patients. Mid-term functional outcome in those surviving is fair.

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Section: Discussionsupporting

confidence: 87%

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

et al. 2020

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“…One-year mortality rates similar for patients, affected by LE and HE fracture mechanisms, confirm results of other studies, where once the patient makes it out of the hospital, further mortality was mostly influenced by general medical status of the patient due to preinjury comorbidities and results of impact of the injury. 1,14,32 Given that the 30-day mortality rate was higher in the HE acetabular group, we want to make clear that this likely results from other factors besides the fracture itself, something implied by the 40% lower difference in associated injury rate and 13 point lower ISS score in the LE group.…”

Section: Discussionmentioning

confidence: 99%

A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

Dyskin

Hill

Torchia

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction: Geriatric patients represent 14% of acetabular fractures and are the fastest growing subset of patients affected by this injury in the US. Treatment outcomes have been reported as inferior to those achieved in younger patients after high-energy (HE) acetabular trauma. This study aimed to compare detailed demographic characteristics and clinical outcomes in elderly patients (≥65 years of age) treated in a tertiary North American trauma center for acetabular fractures after both high- and low-energy mechanisms of injury. Methods: Patients (≥65 years of age) diagnosed with an acetabular fracture were identified over a 7-year period. Patient and injury characteristics were extracted from our institutional trauma database. Length of stay, intervention, operative details, disposition, complications, readmissions, and mortality were analyzed. Results: One hundred nine patients were identified for inclusion. Low-energy mechanisms (simple falls) were found in 64 (58.7%) and HE mechanisms in 45 (41.3%) patients. The HE cohort was younger (74.6 vs 80.7 years; P < .001), had a higher male predominance (76% vs 56%; P = .10), a lower Charlson comorbidity index (1.29 ± 1.49 vs 2.16 ± 1.76; P = .01), and a higher injury severity score (19.90 ± 15.33 vs 6.46 ± 3.57; P < .001). Fracture patterns, described according to the Letournel-Judet classification, were similar between the 2 groups. Thirty-day mortality was significantly higher in the HE group (26.7% vs 3.1%; P < .001); however, the 1-year mortality rates were not statistically different (31.1% vs 25.0%; P = .20). Discussion: Patients with acetabular fractures sustained due to HE accidents demonstrate significantly higher 30-day mortality rate than patients with low-energy fractures, but similar mortality 1 year after the injury, despite having a much lower mean age and fewer comorbidities. Conclusion: Medical efforts made during initial hospital admission may have the biggest impact on survivorship following acetabular fracture.

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“…15 In the current study, the authors similarly found that increasing age was among the most significant predictors of mortality and major systemic complications, while obesity (body mass index ≥30 kg/m 2 ) was the only comorbidity associated with a significant impact on both outcomes. Both age [8][9][10]15,28 and obesity 16,22,24,[29][30][31] have been shown in more limited series to impact perioperative mortality and major systemic complications in pelvic and lower extremity trauma. Furthermore, obesity is the only medical comorbidity e226 cited in the literature to correlate with increased risk of mortality 16,24 and perioperative complications such as deep venous thrombosis and local wound infection for patients with fractures of the acetabulum.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Inpatient Mortality and Systemic Complications in Acetabular Fractures Requiring Operative Treatment

2017

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Patient demographics, physiologic variables, and injury characteristics predictive of mortality and major systemic complications following operative fixation of acetabulum fractures were identified using the National Sample Program of the National Trauma Data Bank. Age older than 60 years, obesity, and Injury Severity Score greater than 15 portended a statistically significant increase in mortality and major systemic complications (P≤.05). Systolic blood pressure less than 90 mm Hg and Glasgow Coma Scale score less than 8 were also significant predictors of mortality and major systemic complications (P<.0001). Time to surgery and hospital length of stay did not affect mortality. The most common potentially modifiable risk factors were smoking (22.3%) and obesity (body mass index ≥30 kg/m) (9.1%). Increasing age, Injury Severity Score, and obesity independently predicted a statistically significant increase in both mortality and major systemic complications. A better understanding of the associated risk factors and unique complication profile will provide orthopedic surgeons with a basis on which to effectively counsel and care for patients. [Orthopedics. 2017; 40(2):e223-e228.].

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One-Year Mortality After Acetabular Fractures in Elderly Patients Presenting to a Level-1 Trauma Center

Abstract: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 37 publications

References 13 publications

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

Mortality, complications and long-term functional outcome in elderly patients with fragility fractures of the acetabulum

A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients

Predictors of Inpatient Mortality and Systemic Complications in Acetabular Fractures Requiring Operative Treatment

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