Format

Send to

Choose Destination
Injury. 2018 Mar;49(3):685-690. doi: 10.1016/j.injury.2018.02.004. Epub 2018 Feb 6.

Factors influencing survival following hip fracture among octogenarians and nonagenarians in the United States.

Author information

1
Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, United States. Electronic address: sbokshan@lifespan.org.
2
Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, United States.
3
Department of Orthopaedics, Division of Orthopaedc Trauma, Alpert Medical School of Brown University, Providence, RI, United States.

Abstract

INTRODUCTION:

Hip fractures account for a significant disease burden in the Unites States. With an aging population, this disease burden is expected to increase in the upcoming decades.

MATERIALS AND METHODS:

This represents a retrospective cohort study to assess mortality following hip fracture in the octogenarian and nonagenarian populations. Odds ratios for postoperative mortality were constructed using normalized patients from United States Social Security death tables. Kaplan Meier analysis and binary logistic regression were used to assess the impact of surgical delay and medical comorbidity (measured by the Carlson Comorbidity Index (CCI)) on postoperative mortality.

RESULTS:

189 octogenarians and 95 nonagenarians were included. One-year mortality was nearly three times higher for both the octogenarians (OR: 3.1) and nonagenarians (OR: 3.14), and returned to that of the normal population 4 years post-op for octogenarians and 5 years post-op for nonagenarians. Higher preoperative medical comorbidity (CCI) was associated with higher post-op mortality for both octogenarians (log rank = 0.026) and nonagenarians (log rank = 0.034). A 48-h surgical delay resulted in significantly increased postoperative mortality among healthy patients (CCI of 0 or 1, OR: 18.1), but was protective for patients with significant medical comorbidity (CCI ≥ 3). Age, preoperative CCI, and 48-h surgical delay were all independent predictors of 1-year post-op mortality.

CONCLUSIONS:

Following hip fracture, there is a 3-fold increase in mortality for octogenarians and nonagenarians at 1 year post-op. A 48-h surgical delay significantly increased mortality for healthier patients but was protective against mortality for sicker patients.

KEYWORDS:

Delay; Hip fracture; Mortality; Nonagenarian; Octogenarian; Survival

PMID:
29426609
DOI:
10.1016/j.injury.2018.02.004
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center