Abstract
Background
Lethal events represent the most important complication in the treatment of hip fracture in elderly patients. Despite the increasing chance for treatment of such conditions, few data regarding risk factors associated with lethal events have been determined for ordinary hospitals with limited medical and human resources, particularly in Japan.
Methods
The incidence of postoperative lethal events and related preoperative risk factors in extremely elderly patients (>80 years) with hip fracture were retrospectively analyzed in our hospital for the past 2 years.
Results
Lethal events occurred in 11 (10.7%) of 103 patients within 3 months postoperatively. In both univariate and multivariate analyses, an elevated number of co-morbidities and preoperative respiratory dysfunction were identified as significant risk factors. Delay in surgery was not a risk factor for lethal events.
Conclusions
A valid reason for delay is the need to stabilize concurrent medical conditions due to multiple co-morbidities in extremely elderly patients with hip fracture. Considering the limited resources and extreme age of the subjects, the mortality rate in the present study was quite acceptable. Patients, families of patients, and physicians should recognize the increased risk of mortality for patients with significant risk factors in the surgical treatment of hip fracture.
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References
Furlaneto ME, Garcez Leme LE. Impact of delirium on mortality and cognitive and functional performance among elderly people with femoral fractures. Clinics (Sao Paulo) 2007;62:545–552.
Maggi S, Siviero P, Wetle T, Besdine RW, Saugo M, Crepaldi G. A multicenter survey on profile of care for hip fracture: predictors of mortality and disability. Osteoporos Int 2010;21:223–231.
Geiger F, Zimmermann Stenzel M, Heisel C, Lehner B, Daecke W. Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality. Arch Orthop Trauma Surg 2007;127:959–966.
Penrod JD, Litke A, Hawkes WG, Magaziner J, Doucette JT, Koval KJ, et al. The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 2008;63:867–872.
Bergeron E, Lavoie A, Moore L, Bamvita JM, Ratte S, Gravel C, et al. Is the delay to surgery for isolated hip fracture predictive of outcome in efficient systems? J Trauma 2006;60:753–757.
Souza RC, Pinheiro RS, Coeli CM, Camargo KR Jr. The Charlson comorbidity index (CCI) for adjustment of hip fracture mortality in the elderly: analysis of the importance of recording secondary diagnoses. Cad Saude Publica 2008;24:315–322.
Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop 2004;425:64–71.
Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 2008;55:146–154.
Muraki S, Yamamoto S, Ishibashi H, Nakamura K. Factors associated with mortality following hip fracture in Japan. J Bone Miner Metab 2006;24:100–104.
Sakamoto K, Nakamura T, Hagino H, Endo N, Mori S, Muto Y, et al. Report on the Japanese Orthopaedic Association’s 3-year project observing hip fractures at fixed-point hospitals. J Orthop Sci 2006;11:127–134.
Orosz GM, Hannan EL, Magaziner J, Koval K, Gilbert M, Aufses A, et al. Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc 2002;50:1336–1340.
Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ 2006;332:947–951.
Shah MR, Aharonoff GB, Wolinsky P, Zuckerman JD, Koval KJ. Outcome after hip fracture in individuals ninety years of age and older. J Orthop Trauma 2001;15:34–39.
Majumdar SR, Beaupre LA, Johnston DW, Dick DA, Cinats JG, Jiang HX. Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study. Med Care 2006;44:552–559.
Franzo A, Francescutti C, Simon G. Risk factors correlated with postopoerative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 2005;20:985–991.
Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA. Survival after hip fracture. Osteoporos Int 2005;16:1583–1590.
Wang J, Jiang B, Marshall RJ, Zhang P. Arthroplasty or internal fixation for displaced femoral neck fractures: which is the optimal alternative for elderly patients? A meta-analysis. Int Orthop 2009;33:1179–1187.
Smektala R, Endres HG, Dasch B, Maier C, Trampisch HJ, Bonnaire F, et al. The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord 2008;9:171.
Paksima N, Koval KJ, Aharanoff G, Walsh M, Kubiak EN, Zuckerman JD, et al. Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis 2008;66:111–117.
Karagiannis A, Papakitsou E, Dretakis K, Galanos A, Megas P, Lambiris E, et al. Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type of fracture. Calcif Tissue Int 2006;78:72–77.
Japanese Orthopaedic Society, Committee for Osteoporosis. Result of questionnaire on preoperative waiting period for hip fracture. J Jpn Orthop Assoc 2009;83:496–499 (in Japanese).
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Takamine, B., Morii, T., Watanabe, H. et al. Short-term postoperative mortality events in patients over 80 years of age with hip fracture: analysis at a single institution with limited medical resources. J Orthop Sci 15, 437–442 (2010). https://doi.org/10.1007/s00776-010-1480-2
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DOI: https://doi.org/10.1007/s00776-010-1480-2