Outcomes After Definitive Surgery for Nonagenarians with Isolated Hip Fractures within 24hours of Admission.

Abstract

Isolated hip fractures are a common orthopedic injury in the elderly population. Estimates are that there will be over 21 million hip fractures globally by 2050. Current recommendations are early operative fixation within 48hours. Despite evidence showing that fixation of hip fractures within 24hours is beneficial in the elderly population, the effect this has on the nonagenarian population has yet to be examined. This is a single institution retrospective cohort study examining isolated hip fractures from 2014 to 2020 from an American College of Surgeons verified trauma center. Patients ≥65years old with IHF were included. A total number of 1150 isolated hip fracture patients 65years or older were included in this study. Three cohorts were examined: (1) patients ≥90years old; (2) patients 65-89years old; and (3) patients stratified by ≥90 vs 65-75years old and ≥90 vs 75-89years old. Patients were then sub stratified by timing of surgery whether it was performed ≤24hours or >24hours. The primary outcome was inpatient mortality. Nonagenarians who had delayed surgery had higher mortality rates compared to nonagenarians with early surgery (15.2% vs 4.2%; P = .02). Patients aged 65-75 had higher complication rates with delayed surgery (12.9% vs 4.1%; P = .01) as did those aged 76-89 (9.0% vs 3.2%, P = .004). Early surgical intervention of isolated hip fractures in the nonagenarian population within 24hours is associated with good clinical outcomes as well as a lower inpatient mortality that approaches significance.