Abstract
BackgroundThe outcomes of nonagenarian patients undergoing orthopaedic surgery are not well understood. We investigated the 30-day mortality after surgical treatment of unilateral hip fracture. The relationship between postoperative complications and mortality was evaluated.MethodsWe performed a single-centre retrospective cohort study of nonagenarian patients undergoing hip fracture surgery over a 6-year period. Postoperative complications were graded according to the Clavien–Dindo classification. Correlation analyses were performed to evaluate the relationship between mortality and pre-specified mortality risk predictors. Survival analyses were assessed using Cox proportional hazards regression modelling.ResultsThe study included 537 patients. The 30-day mortality rate was 7.4%. The mortality rate over a median follow-up period of 30 months was 18.2%. Postoperative complications were observed in 459 (85.5%) patients. Both the number and severity of complications were related to mortality (p < 0.001). Compared to patients who survived, deceased patients were more frail (p = 0.034), were at higher ASA risk (p = 0.010) and were more likely to have preoperative congestive heart failure (p < 0.001). The adjusted hazard ratio for mortality according to the number of complications was 1.3 (95% CI 1.1, 1.5; p = 0.003). Up to 21 days from admission, any increase in complication severity was associated significantly greater mortality [adjusted hazard ratio: 3.0 (95% CI 2.4, 3.6; p < 0.001)].ConclusionIn a nonagenarian cohort of patients undergoing hip fracture surgery, 30-day mortality was 7.4%, but 30-month mortality rates approached one in five patients. Postoperative complications were independently associated with a higher mortality, particularly when occurring early.
Highlights
In both absolute numbers, and as a proportion of many Western populations, the number of people in their eighth, ninth and tenth decades continues to increase [1, 2]
Baseline associations with 30‐day mortality Baseline patient characteristics are presented in Table 1 and in Additional file 1
Strengths and limitations Our study presents new data regarding the impact of complications on mortality among nonagenarians having hip fracture surgery
Summary
As a proportion of many Western populations, the number of people in their eighth, ninth and tenth decades continues to increase [1, 2]. 90–99 years) are highly vulnerable to hip fractures and experience increased rates of postoperative morbidity, mortality and adverse functional outcomes [2, 5, 6]. While some international literature has reported on the preoperative, surgical and anaesthetic factors affecting postoperative outcomes in nonagenarian patients [2, 7, 8], no comparative data exist in the Australian context. The majority of existing data focus on preoperative factors affecting post-surgical outcomes, including time to surgery, patient comorbidity and advanced age [2, 7, 8]. There remains a dearth of international data assessing the impact of complications and perioperative factors on short- and long-term mortality among nonagenarians. The relationship between postop‐ erative complications and mortality was evaluated
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
