Perioperative management of concomitant diseases and complications of hip fracture in patients aged 80 year and over

Abstract

Objective To investigate the clinical treatment strategy of concomitant diseases and perioperation complications in elderly patients with hip fracture aged ≥ 80 years and the clinical prognosis. Methods A retrospective analysis was conducted in 95 hip fracture patients aged 80 and over years(80~90 years old) undergoing operation.There were 42 cases with femoral neck fractures and 53 cases with intertrochanteric fracture.71 cases (74.7%) had preoperative concomitant medical diseases.Screw fixation was performed in 3 cases (3.2%), hemiarthroplasty in 75 cases (78.9%), total hip replacement in 4 cases (4.2%), proximal femoral nail antirotation (PFNA) in 9 cases (9.5%) and reconstruction interlocking nail fixation in 4 cases (4.2%). Results No mortality was found during hospitalization.Postoperative anemia was the most common (74.7%), followed by hypoproteinemia (68.4%), digestive disorders (30.5%), electrolyte disturbance (28.4%) and psychiatric symptoms (15.8%). At least one-year follow-up was made in 73 cases.39 cases (53.4%) acquired independent activities after surgery, 48 (65.8%) patients recovered to the preoperative level of activity.The concomitant diseases before surgery (OR=0.23, P=0.011), preoperative ability of activity (OR=0.23, P=0.025), the American Society of Anesthesiology (ASA) classification (OR=0.19, P=0.025) were the related factors influencing the one-year mortality. Conclusions The treatment of concomitant diseases should be emphasized in treating fracture.The active prevention during preoperative, intraoperative, postoperative period could reduce or avoid fatal complications and acquire good functions. Key words: Hip fractures; Perioperative care; Postoperative complications