Abstract
IntroductionHip fracture is a common and serious orthopedic injury among the geriatric population, necessitating surgical treatment. We tested whether age is a significant risk factor for in-hospital mortality after surgery in this retrospective cohort study and, further, analyzed causes and pattern of death in those patients.MethodsWe queried the electronic hospital records of in-patients aged over 75 years who had undergone hip fracture surgery from the start of 2010 to the end of August 2016 in our hospital, a tertiary hospital on the main island of Japan. The extracted data included patient ID, age, gender, location of fracture, ASA-PS scores, types of anesthesia, durations of anesthesia and surgery, days of hospital stay after surgery, and outcomes at hospital discharge including in-hospital death. The extracted data were divided into two groups based on the patient’s age at the time of surgery: the aged group (age of < 85) and the advanced age group (age of ≥ 85 years), and we compared patient characteristics and management variables and discharge disposition between the two groups.ResultsEight hundred four patient records were extracted (360 in the aged and 444 in the advanced age groups). Although a smaller proportion of patients in the advanced age group could be discharged home, all-cause in-hospital mortality was also similar between the two groups (1.9 and 1.6%, aged and advanced age groups, respectively). Six patients died from advanced cancer, and five patients died of pneumonia resulting from aspiration.ConclusionsThe results of this study suggest that age is not a clinically significant risk factor for in-hospital mortality. The possibility decreasing in-hospital mortality exists in identifying patients at risk of aspiration and preventing it.
Highlights
Hip fracture is a common and serious orthopedic injury among the geriatric population, necessitating surgical treatment
Comparison in-hospital mortality between the aged and advanced age groups Demographic data showed some differences between two groups, and there was a slightly higher proportion of females and extra-capsular fractures in the advanced age group (Table 1)
While ASA score did not differ between the two groups, a greater proportion of patients in the advanced age group underwent spinal anesthesia, and durations of anesthesia and surgery were shorter in the advanced age group than the aged group
Summary
Hip fracture is a common and serious orthopedic injury among the geriatric population, necessitating surgical treatment. We tested whether age is a significant risk factor for in-hospital mortality after surgery in this retrospective cohort study and, further, analyzed causes and pattern of death in those patients. Age is one of the significant predictors for increased mortality, it may be a surrogate measure for other variables, especially since frailty or reduced functional capacity rather than chronological age predict postoperative mortality after surgery overall [3–5]. Causes and pattern of death after hip fracture surgery are not well understood, and the need to improve postoperative mortality after hip fracture is clear. We used the database of hip fracture patients in our hospital to analyze causes and pattern of death. We hypothesized that if age is a clinically significant factor for mortality after hip fracture surgery, there should be a difference between groups when stratified by chronological age
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