Mortality and Morbidity in Nonagenarian Patients following Hip Fracture Surgery

Abstract

Background: The number of people living more than 90 years is increasing, and this population shows a high incidence of hip fractures. Objective: To study prospectively the mortality and morbidity following hip fracture surgery in nonagenarian patients. Methods and Subjects: 106 nonagenarian patients were admitted for femoral neck fracture and treated surgically in the traumatology and geriatric departments of two university hospitals. All patients received comprehensive geriatric assessment. 75 patients were followed up after a 3-month control period. Mortality and functional status were assessed using the Barthel index (BI) and mobility, dependency on walking aids, residential status, and degree of residual pain were the items assessed for morbidity. Results: In-hospital mortality was 10%; the 3-month accumulate mortality was 20%. The mean BI of the 75 patients who survived was 53 showing a persistent decrease compared with their BI previous to the hip fracture (79; p < 0.003). The decline in BI after 3 months persisted in 91% of patients. Before injury, 11% patients were housebound, while 45% were housebound 3 months later. 54% were independent before the fracture occurred, and only 16% 3 months later. Only 12% of patients who survived were unable to return to their pre-admission dwelling. Conclusions: Findings of low perioperative mortality and acceptable morbidity support the view that surgery followed by rehabilitation is indicated in selected nonagenarian patients.