Survivorship and Severe Complications Are Worse for Octogenarians and Elderly Patients with Pelvis Fractures as Compared to Adults: Data from the National Trauma Data Bank

Abstract

Purpose. This study examined whether octogenarians and elderly patients with pelvic fractures have a different risk of complication and mortality as compared to adults. Methods. Data was gathered from the National Trauma Data Bank from 2002 to 2006. There were 32,660 patients 18–65, 6,408 patients 65–79, and 5,647 patients ≥ 80 years old with pelvic fractures. Descriptive statistics and bivariate and multivariate analyses were performed with the adult population as a referent. Results. Multivariate analysis showed 4.7-fold higher odds of death and 4.57 odds of complications in the octogenarian group after a pelvic fracture compared to adults. The elderly had 1.81-fold higher odds of death and 2.18-fold higher odds of severe complications after sustaining a severe pelvic fracture relative to adults. An ISS ≥ 16 yielded 15.1-fold increased odds of mortality and 18.3-fold higher odds of severe complications. Hypovolemic shock had 7.65-fold increased odds of death and 6.31-fold higher odds of severe complications. Between the ages of 18 and 89 years, there is approximately a 1% decrease in survivorship every 10 years. Conclusions. This study illustrates that patients older than 80 years old with pelvis fractures have a higher mortality and complications rate than elderly or adult patients.

Severe Pelvic Fracture in the Elderly: High Morbidity, Mortality, and Resource Utilization

“…Others have shown that age, 13 the presence of shock on admission, and ISS score to be significant predictors of mortality which strongly supported our findings. 7 Interestingly, O'Brien et al found GCS, gender, and PF AIS to have no effect on mortality, results opposed to ours, which may be due to their smaller sample size (n = 305), the classification method of PF severity, and the inclusion of patients aged <65 years.…”

“…12 Similar to our results, Matityahu et al reported older patients suffered more low energy falls rather than MVC. 7 However, a study performed by O'Brien et al found MVC followed by pedestrian struck to be more common in patients aged ≥55 years. 13 It is possible this is due to the study's smaller size (n = 57) or the inclusion of patients aged 55-64 years.…”

“…Their overall sample size in each AIS category was significantly lower than those in the present study. 7 The most common mechanisms of injury unrestricted by age are MVC, pedestrian struck, falls, and motorcycle accidents in the United States, [8][9][10][11] but worldwide variation exists with pedestrian struck being most common in Brazil. 12 Similar to our results, Matityahu et al reported older patients suffered more low energy falls rather than MVC.…”

“…Matityahu et al found that in patients ≥65 years of age with pelvic AIS ≥3, only 1 out of 899 received internal fixation. 7 Henry et al found that 62% received blood transfusion, 5.1% had open internal fixation, 2.6% had external fixation, none had both internal and external procedures, and 15.9% required angiography. In our study, we found that 21% received blood transfusion, 16% underwent internal fixation, and 8.7% required angiography.…”

Obstetrician/Gynecologist Care Considerations: Practice Changes in Disease Management with an Aging Patient Population

“…Bone loss increases in women as they age result ing in widespread health problems, including chronic pain and fractures [21]. In addition, these risks contribute to shortened lifespan and reduced quality of life [22]. Increased cognizance regarding the health impacts of bone loss in later life, as well as the increasing frequency of such cases in ob/gyn practices, may mean that ob/gyns should pay closer attention to possible signs of bone loss in their patients.…”