Abstract
IntroductionThis study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures.Materials and methodsA retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72 h and after 72 h. Kaplan–Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models.ResultsOf 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery (fracture fixation within or greater than 72 h), there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72 h were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index (CCI) and pre-op mobility status were associated with statistically significant differences in overall mortality. The same factors were associated with a significantly increased hazard of death in the multivariate Cox proportional hazards model. Patient gender, mechanism of injury, Injury Severity Score (ISS) > 15 and head injury were not significant predictors of mortality.ConclusionSurgical intervention within 72 h of injury did not result in decreased mortality in older patients with PA fractures. The 1-year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach between orthogeriatric and expert PA surgeons for these patients.
Highlights
This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures
PA fractures through physiological derangement and pain may lead to prolonged immobility, which has a demonstrable effect on mortality in the elderly [3]. 1-year mortality rates for conservatively and surgically managed older patients sustaining PA fractures range from 16 to 33% for acetabular fractures [4, 5] to 27% for pelvic fractures [6]
In the hip fracture population, time to surgical intervention has been shown to be a significant factor in predicting mortality in geriatric patients with hip fractures [7, 8] with surgical intervention for hip fractures in the elderly required within 36 h of injury in the UK to qualify for Best Practice Tariffs (BPT) [17]
Summary
This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures. Conclusion Surgical intervention within 72 h of injury did not result in decreased mortality in older patients with PA fractures. The demographics of the polytrauma patient have changed over time; most notably with mean age, increased from 36 in 1990 to 54 years in. With the contribution of isolated fragility fractures and polytrauma in the older patient there is a predicted significant increase in the incidence of pelvic and acetabular (PA) fractures in the older population [2]. 1-year mortality rates for conservatively and surgically managed older patients sustaining PA fractures range from 16 to 33% for acetabular fractures [4, 5] to 27% for pelvic fractures [6]. While the relationship between early surgical intervention and mortality reduction in proximal and distal
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