Abstract
BackgroundIn light of poor outcomes with nonoperative management of hip fractures, orthopedic surgeons are faced with difficult decisions about which patients are too ill or too old for surgical treatment.Questions/PurposesThis study sought to investigate if patients over 90 years had different preoperative laboratory, clinical, and injury characteristics than younger patients with the same injury. We compared our cohort with previously published data. We wished to identify if there were pre-injury risk factors associated with 30-day mortality, which could be modified to enhance postoperative outcomes.MethodsThis is a retrospective review of 198 operatively managed hip fractures in patients 75 years or older. We collected data on demographics, select preoperative laboratory values, injury type, comorbidities, and 30-day mortality.ResultsEleven (5.6%) of the cohort died within 30 days of surgery, 6.3% in the younger group, and 3.7% in the older group; the difference was not statistically significant. For baseline characteristics, there was no difference between the age groups for pre-injury comorbidities, hemoglobin, serum albumin, BUN, prevalence of UTI, or fracture type. A total of 67 (35.8%) patients had evidence of UTI on admission.ConclusionsThese findings reveal that in our dichotomized cohort, pre-injury characteristics were similar and age alone was not an independent predictor of mortality. These data may inform decision-making for orthopedic surgeons and the medical providers who consult to optimize these patients for surgery. We identified high rates of UTI in both age groups, a potentially remediable factor to optimize outcomes in hip fracture surgery in elderly patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-015-9435-y) contains supplementary material, which is available to authorized users.
Highlights
Hip fractures are a significant cause of morbidity, mortality, and health care consumption in the elderly, accounting for 258,000 hospital admissions per year in the USA [13]
Background: In light of poor outcomes with nonoperative management of hip fractures, orthopedic surgeons are faced with difficult decisions about which patients are too ill or too old for surgical treatment
We identified high rates of urinary tract infection (UTI) in both age groups, a potentially remediable factor to optimize outcomes in hip fracture surgery in elderly patients
Summary
Hip fractures are a significant cause of morbidity, mortality, and health care consumption in the elderly, accounting for 258,000 hospital admissions per year in the USA [13]. There is evidence that incidence of hip fracture is declining, prevalence of comorbidities among these patients is increasing [4]. In light of poor outcomes with nonoperative management, orthopedic surgeons must decide which patients are too ill, too frail, or too old for surgical treatment. This controversy faces orthopedic surgeons every day and around the world. In light of poor outcomes with nonoperative management of hip fractures, orthopedic surgeons are faced with difficult decisions about which patients are too ill or too old for surgical treatment.
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