Further experience of nonagenarians with hip fractures

Sex differences in short- and mid-term survival in femoral neck fracture patients aged over 90 years: A retrospective cohort study

OBJECTIVES

The primary purpose of this retrospective study was to evaluate the sex differences in short- and mid-term mortality in femoral neck fracture patients aged >90 years treated operatively and nonoperatively over a 10-year period.

METHODS

From January 2007 to December 2016, all femoral neck fractures patients (aged over 90 years) admitted to our hospital were included for evaluation. The survival time and mortality rate were compared between patients treated by arthroplasty and those treated nonoperatively. Additionally, a Cox proportional hazards model was built to explore the treatment effect difference between the arthroplasty group and the nonoperative group with sex-stratified subgroups.

RESULTS

The difference in the survival distribution between the nonoperative and arthroplasty groups were significant for women (P = 0.002) but not for men (P = 0.6222). The adjusted hazard ratio (95% confidence interval) of nonoperative treatment to arthroplasty was 3.93 (1.86, 8.31). The adjusted risk ratios of nonoperative treatment to arthroplasty for males and females were 1.24 (0.58, 2.67) and 34.04 (8.68, 133.47), respectively. The data also showed higher short- and midterm survival rates in women than in men among the arthroplasty group, especially within the first 1-3 years after injury.

CONCLUSIONS

Arthroplasty can significantly improve short- and mid-term survival in femoral neck fracture patients aged over 90 years, especially females. The most significant difference in mortality between the two sexes was observed within the first three years following the fracture.

Outcomes in Nonagenarians with Hip Fractures Treated Conservatively and Surgically

Introduction

We aimed to assess the clinical outcomes in nonagenarians following a hip fracture. We also further investigated the factors that influence these outcomes, such as method of treatment (operative versus conservative), co-morbidities, and pre-morbid function.

Materials and methods

We studied 65 nonagenarians that were identifiable from our hospital hip fracture database. We reviewed various parameters of these patients admitted after sustaining a hip fracture (neck of femur or intertrochanteric) and investigated how these parameters affected patient outcomes. The main outcomes studied were: inpatient morbidity, and mortality at one year.

Results

Inpatient morbidity was more likely in patients with an ASA grade of 3 to 5. Urinary tract infection was the most common medical complication. The 1-year mortality was 15.4% and was significantly influenced by advancing age. Surgically managed patients had a 1-year mortality rate (14.3%) slightly less than non-operative patients (17.4%). Post injury mobility was significantly better in those who received operative treatment with 63% of surgical cases regaining ambulatory status versus 7% of conservatively managed patients.

Conclusions

We presented the outcomes of hip fractures in an extreme age group in the population. In nonagenarians with hip fractures surgery was associated with a 1-year mortality rate of 14.3% which is comparable to the general hip fracture population and less than the mortality rate of conservatively managed patients (17.4%). The primary advantage of surgery would be that two-thirds of patients return to ambulatory status. This information is useful to counsel patients and their families especially since the elderly are often more fearful of surgical intervention.

Evaluation of Nutritional Status and Correlation with Postoperative Complications in Elderly Patients Submitted to Surgical Treatment of Proximal Femoral Fractures

Objective  This study aims to evaluate and correlate the nutritional status with potential complications during the immediate postoperative period of elderly patients surgically treated for proximal femoral fractures.

Methods  A prospective, cross-sectional analytical study with a quantitative approach, targeting patients aged 60 years old or more who were admitted to a hospital in Amazonas, Brazil, for surgical treatment of proximal femoral fractures. Surgical complications during the immediate postoperative period and their relationship with the nutritional status of the patient were determined using the mini nutritional assessment (MNA); in addition, the lymphocyte numbers and serum albumin levels were determined and correlated with the length of hospital stay.

Results  The sample consisted of 19 elderly patients, of both genders, with a mean age of 70.8 years. Most of the subjects (68.4%) were female. Malnutrition was diagnosed in 15.8% of the subjects using the body mass index (BMI) as, an anthropometric variable, and the MNA identified 31.6% of the subjects with malnutrition. Regarding total lymphocyte count, 100% of the sample showed a positive association with malnutrition in varying degrees; using serum albumin level as a parameter, malnutrition was identified in 89.4% of the subjects. Malnourished patients had the highest average length of stay. Surgical complications as surgical site infections occurred in 10.5% of the patients at risk of malnutrition.

Conclusion  This study revealed a higher rate of postoperative complications in elderly patients diagnosed with malnutrition.

Operative Fixation of Hip Fractures in Nonagenarians: Is It Safe?

BACKGROUND

With the shift in hip fracture epidemiology toward older individuals as well as the shift in demographics toward nonagenarians, it is important to understand the outcomes of treatment for these patients.

METHODS

Geriatric patients (≥65 years old) who underwent surgery for hip fracture were identified in the 2005-2017 National Surgical Quality Improvement Program database and stratified into 2 age groups: <90 and ≥90 years old (nonagenarians). Preoperative and procedural characteristics were compared. Multivariate regressions were used to compare risk for complications and 30-day readmissions. Risk factors for serious adverse events (SAEs) and 30-day mortality in nonagenarians were characterized.

RESULTS

This study included 51,327 <90 year olds and 15,798 nonagenarians. Overall rate of SAEs in nonagenarians was 19.89% while in <90 year olds was 14.80%. Multivariate analysis revealed higher risk for blood transfusion (relative risk [RR] = 1.21), death (RR = 1.74), pneumonia (RR = 1.24), and cardiac complications (RR = 1.33) in nonagenarians (all P < .001). Risk factors for SAEs in nonagenarians include American Society of Anesthesiologists ≥3, dependent functional status, admitted from nursing home/chronic/intermediate care, preoperative hypoalbuminemia, and male gender (all P < .05), but not time to surgery (P > .05). In fact, increased time to surgery in nonagenarians was associated with lower risk of 30-day mortality (RR = 0.90, P = .048).

CONCLUSION

Overall complication risk after hip fracture fixation in nonagenarians remains relatively low but higher than their younger counterparts. Interestingly, since time to surgery was not associated with adverse outcomes in nonagenarians, the commonly accepted 48-hour operative window may not be critical to this population. Additional time for preoperative medical optimization in this vulnerable population appears prudent.

Hip Fracture in Nonagenarians: Characteristics and Factors Related to 30-Day Mortality in 1177 Patients

BACKGROUND

The number of nonagenarian patients with hip fracture is increasing. The goals of this study were to describe the characteristics and in-hospital course of a cohort of 1177 nonagenarians admitted for hip fracture compared with younger patients and to identify risk factors for 30-day mortality after admission.

METHODS

This is a retrospective observational cohort study including patients aged 65 years or older admitted for hip fracture during various periods from February 1997 to December 2016. We defined 3 age groups: 65-79, 80-89, and 90 years and older. We included sociodemographic variables, baseline functional status, comorbidities, fracture and surgical characteristics, postoperative complications, length of stay, and in-hospital and 30-day mortality. Multiple logistic regression analysis was used to study risk factors for 30-day mortality in surgically treated nonagenarians.

RESULTS

Nonagenarians were more likely to be women and to have dementia and heart disease. Some 72% walked independently before the fracture. The most relevant treatable risk factor for 30-day mortality in nonagenarians (in terms of higher odds ratio [OR]) was developing respiratory infection (OR: 4.56, 95% confidence interval [CI]: 2.73-7.63). Better prefracture functional status (higher Katz score; OR: 0.83, 95% CI: 0.74-0.92) and spinal anesthesia (OR: 0.19, 95% CI: 0.05-0.68) decreased risk of 30-day mortality.

CONCLUSIONS

Nonagenarian patients with hip fracture differ significantly from younger patients concerning clinical characteristics, medical complications, and in-hospital and 30-day mortality rates. We identified several variables on which we could act to reduce 30-day mortality, such as respiratory infection, electrolyte disorders, polypharmacy, cardiac arrhythmia, and spinal anesthesia.

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

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.

Mortality, readmission, and reoperation after hip fracture in nonagenarians

Background

Osteoporotic hip fractures are associated with high mortality and morbidity in people of advanced age; however, few studies have investigated the complication rates in nonagenarians. In this study, we applied a competing risk analysis to estimate the mortality, readmission, and reoperation rates after surgery for hip fracture among nonagenarians.

Methods

A total of 11,184 nonagenarians (aged ≥ 90) who received surgery for hip fracture during the period 1 January 1997 and 31 December 2010 were selected from Taiwan’s National Health Insurance (NHI) database. Nonagenarians were followed up until the end of 2012, death, or the date they left the NHI program. Cumulative mortality was estimated using the Kaplan-Meier analysis and risk factors for mortality were investigated using a Cox proportional hazards model. Competing risk analysis was used to estimate cumulative incidence rates and to assess the risk factors for reoperation and readmission.

Results

The mortality rates were 29.5% at 1 year, 45.0% at 2 years and 78.1% at 5 years. The cumulative incidence rates of reoperation were 7.3% at 1 year, 9.2% at 2 years and 11.6% at 5 years whereas those of readmission were 18.9% at 1 month and 24.1% at 3 months. Significant risk factors for death included age, male gender, trochanteric fracture, and higher Charlson comorbidity index (CCI) whereas those for reoperation were age, cervical fracture and higher CCI. Furthermore, age, male gender, and higher CCI were risk factors for readmission.

Conclusions

The overall 2-years mortality rate among nonagenarians in Taiwan was around 45%, the 2-years reoperation rate was around 9% and the 90-days medical complication rate was around 24%. High complication rates are associated with increased risk for death. Postoperative care to prevent medical complications is likely the most effective strategy to reduce mortality rates among nonagenarians with hip fracture.

Risk Factors Associated with Dislocation after Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture

Purpose

We investigated the incidence and time of dislocation and other factors associated with dislocation of bipolar hemiarthroplasty related to the treatment of femoral neck fracture in old age patients.

Materials and Methods

Between January 2002 and April 2014, 498 femoral neck fractures (467 patients) were treated with bipolar hemiarthroplasty and included in this study. All surgeries were performed using the postero-lateral approach. The incidence of dislocation was investigated. A comparative analysis between a control group and dislocation group was performed with respect to patient factors including age, gender, body mass index, comorbidities, the ASA (American Society of Anesthesiologists) score, mental status and center-edge angle, and surgical factors including type of femoral stem, leg length discrepancy, femoral offset and method of short external rotator (SER) reconstruction.

Results

The incidence of dislocation was 3.8%, and the dislocation occurred on average 2.2 months (range, 0.6-6.5 months) after operation. No difference in patient-related factors was observed between the two groups. However, a smaller center edge (CE) angle was observed in the dislocation group (42.1°±3.2° vs. 46.9°±5.4°, P<0.001), and significantly lower incidence of dislocation was observed in tendon to bone repair group (0.7% vs 7.8%, P<0.001).

Conclusion

SERs should be repaired using the tendon-to-bone repair method to reduce dislocation rate in elderly patients who undergo bipolar hemiarthroplasty using the postero-lateral approach due to femoral neck fracture. In addition, patients with smaller CE angle should be carefully monitored due to high incidence of dislocation.

Mortality after hip fracture with vertebral compression fracture is poor

Due to the increasing elderly population, the prevalence of osteoporotic hip fractures in Japanese patients continues to rise. It is well established that patients with either hip fracture or both symptomatic and asymptomatic morphometric vertebral compression fracture (VCF) have a poor health prognosis compared with the general population. The purpose of this study was to retrospectively investigate vertebral fracture rates among patients with hip fracture and their influence on mortality. We examined 182 cases of osteoporotic hip fracture in patients admitted to our institution between January 2009 and May 2011. The average age at the time of fracture was 85 years. Radiographs of the lumbar spine were obtained from all of the participants and the lateral spinal radiographs were examined for evidence of VCF. The patients were classified into two groups, those with VCF and those without. A VCF was identified in approximately 78 % of the patients. The mortality rate 1 year after the hip fracture was approximately 22 % and it was significantly higher in patients with VCF. Through multivariate statistics we found that VCF, post-operative complication, loss of ambulation after operation and medication for osteoporosis were statistically significant. In other words, VCF, post-operative complication and loss of ambulation were considered to be poor prognostic factors and medication for osteoporosis was likely to improve the prognosis. We concluded that the risk of mortality after hip fracture is significantly greater in patients who also have VCF compared to patients without VCF, and that medication for osteoporosis is likely to improve prognosis.

Mortality after hip fractures in nonagenarians

Objectives

Nonagenarians with hip fractures represent a special group of people because of their advanced age and co-morbidities. We evaluated mortality after hip fractures in nonagenarians.

Methods

Fifty-one patients were studied over a 2-year period. There were 39 female and 12 male patients. Twenty seven patients sustained an intertrochanteric fracture of the femur, 24 suffered from femoral neck fracture. The American Society of Anaesthetists (ASA) score of II was the most frequent among 51. Forty-one of them had one or more co-morbidities. Patient review was done 2 years after the fracture.

Results

The mortality rate at one year was 53.4% in men, and 15.7% in women. After multivariate analysis, the type of fracture (intertrochanteric fracture) was identified as a risk factor for one-year mortality (P = 0.025).

Conclusion

The outcome in nonagenarians with hip fractures is poor due to the high rates of mortality, especially in men, and this could be informed to patients and their families before hip fracture surgery.

Nonagenarian hip fracture: treatment and complications

BACKGROUND

Hip fracture is a common yet serious injury sustained by the elderly patient and represents one of the major healthcare challenges today. The aim of this study was to better define the unique characteristics of treating nonagenarian peritrochanteric hip fractures and their subsequent complications during hospital stay.

METHODS

Seven hundred twenty-two patients underwent surgery for isolated fracture around the femoral neck. These patients were divided into one of three age groups: A, <50 years; B, 51-89 years; and C, >90 years. We performed a retrospective chart review to compare these groups in terms of patient characteristics, comorbidities, postoperative complications, fracture type, type of surgery performed, and mortality rate.

RESULTS

There was no difference in time to surgery between groups. Comorbidities were similar in groups B and C but were higher than group A. Nonagenarians received a significantly greater percentage of hemiarthroplasties compared with those aged 51 years to 89 years. Cardiac complications were significantly higher in group C. In patients with sustained cardiac complications, the odds ratio for mortality was 15.88.

CONCLUSIONS

Our results suggest that groups B and C were not significantly different pre- or intraoperatively. Nevertheless, there is an increase in cardiac complications and mortality in nonagenarians postoperatively. Nonagenarians should undergo similar treatment in the operating room compared with less elderly patients with the caveat that older patients, especially those with cardiac disease, may be more at risk for complication. The surgeon must evaluate the elderly patient with a hip fracture on a case-by-case basis, while ignoring chronological age.

LEVEL OF EVIDENCE

III, prognostic study.

Outcomes in nonagenarians after hemiarthroplasty for femoral neck fracture. A prospective matched cohort study

A prospective cohort of 33 nonagenarians with hemiartroplasty for femoral neck fracture was matched with 33 patients aged between 70 and 89, using preoperative and postoperative data, and the following were studied; epidemiological data, physical dependence, and SF-12 and WOMAC questionnaires. The mortality rate at one year was 24.2%, influenced by the presence of 3 or more comorbidities, dementia, and previous dependence. The perioperative period was the most vulnerable time, and in some cases delaying surgery should be considered to stabilise the patient's medical condition in very elderly patients. Mortality and functional outcomes were worse than in younger patients, but the surgical complication rate was similar. Prognostic factors for a decline in quality of life were dementia and previous dependence.

Patients with isolated hip fracture must be considered for surgery irrespectively of their age, comorbidity status and provenance: a statement applicable even to nonagerians

INTRODUCTION

Hip fractures are associated with high rates of adverse outcome but previous research has not lead to the identification of any subgroups for whom surgery could be contraindicated. The purpose of this study was to identify factors that could help in the decision making process.

MATERIALS AND METHODS

We identified 965 consecutive patients operated for an isolated hip fracture from 1 April 1996 to 31 March 2003 in a single large volume centre. We collected information on age, gender, comorbidities and place of injury (in-house, outdoors, nursing home). Outcome measures were mortality and orientation at discharge. Multiple logistic regression and recursive partitioning were used to identify factors associated with poor outcome.

RESULTS

Median age was 81.4 with 121 patients aged 90 and over. Seventy-six percent were female. The fall occurred at home in 59%, outdoors in 19% and at a nursing home in 22%. Death was significantly associated with the number of comorbidities, age and place of injury. Dementia (23%) was the most significant predictor of orientation to a new nursing home. Among 121 nonagerians, 89 survived and 59 returned home. Among 53 nonagerians with two or more comorbidities, 34 survived and 20 returned home.

CONCLUSIONS

Comorbidities, age and provenance of patients appear to be the most significant factors associated with adverse outcome. However, even among nonagerians with a heavy comorbidity burden, results do not contraindicate surgical intervention.

Centenarians versus patients within the most frequent age range for hip fractures: transfusion practice

INTRODUCTION

Descriptive retrospective review to compare transfusion among centenarians operated for a hip fracture with a control group within the "typical" age range for that surgery.

METHOD

Fractured centenarians admitted between 2001 and 2006 were compared with a randomly selected control group aged 75-83 years, with the same pathology. Main variables recorded: demographic data; pre- and post-operative status; haemoglobin levels and blood use. A comparative statistical analysis was performed.

RESULTS

Both groups were similar: each had 17 patients and a majority of females had a pertrochanteric hip fracture. Although there was a trend towards higher comorbidity rates and transfusion indexes among centenarians, a significant difference could only be found in post-operative and trigger haemoglobin levels, and in the incidence of post-operative complications.

CONCLUSION

Despite intuitive beliefs, centenarians had results similar to those of the younger population: only a higher complication rate could be proved. Larger samples and prospective studies might be needed to confirm the trends noted.

[Acute orthogeriatric care (II). Clinical aspects]

The present article reviews the clinical principles of acute orthogeriatric care. The application of geriatric medicine to patients with hip fracture is explained. The principal stages of geriatric intervention in this process are mentioned, as are the interventions to be carried out by the geriatric team. Subsequently, we discuss the management of several frequent problems in these patients, such as high surgical risk, pain management, anaemia, delirium, malnutrition, and discharge planning. Lastly, the characteristics of several kinds of patients with special characteristics are mentioned, such as those diagnosed with dementia, nursing home residents or the oldest-old. Areas of improvement in the acute phase are also reviewed, such as mortality reduction, functional outcome improvement and the need for more efficient resource use in patients in the acute phase of hip fracture.

Outcome after surgery for the treatment of hip fracture in the extremely elderly

BACKGROUND

As a consequence of changes in population demographics, the extremely elderly represent one of the fastest growing groups in Western society. Previous studies have associated advanced age with increased mortality after hip fracture; however, this finding has not been consistent.

METHODS

The Scottish Hip Fracture Audit is a prospective, national, multicenter study that collects data on patients over the age of fifty years who are admitted to the hospital with a hip fracture. For the present study, we used data collected from twenty-two acute-care orthopaedic units between January 1998 and December 2005. The extremely elderly cohort consisted of 919 individuals with an age of ninety-five years or more. Case-mix variables and outcomes were compared with those for a modal control group of 15,461 individuals who were seventy-five to eighty-nine years of age. Outcome measures included thirty and 120-day mortality rates, the length of the hospital stay, the place of residence, and mobility. A multivariable logistic regression model was used to compare outcomes between groups while controlling for significant case-mix variables.

RESULTS

The extremely elderly presented with poorer indicators of health status as demonstrated by higher American Society of Anesthesiologists scores. In addition, this group was less likely to be independently mobile and more likely to be in institutional care at the time of the fracture (p < 0.001). Mortality at thirty and 120 days was higher in the extremely elderly even after adjusting for case-mix variables. The extremely elderly also were less likely to return home or to return to previous levels of mobility.

CONCLUSIONS

Although the extremely elderly exhibited a higher prevalence of prefracture indicators of poor outcome, statistical control for these case-mix variables showed further age-related deterioration in survival and outcomes after surgery for the treatment of a hip fracture.

[Risk adjustment measures for mortality after hip fracture]

OBJECTIVE

To assess factors associated to mortality in patients with hip fracture and to describe different risk adjustment measures.

METHODS

Non-concurrent cohort study comprising 390 patients aged 50 years and more. Patients were identified from the Brazilian Unified Health System Hospital Information System, admitted for hip fracture surgery in a teaching hospital in Rio de Janeiro, southeastern Brazil, between 1995 and 2000. Data from medical records were collected and analyzed by logistic regression models to study 90-day mortality odds after admission according to patient and treatment profiles. Severity of illness classification indexes were estimated.

RESULTS

Mortality rate was 7.4% and factors affecting mortality were age (OR=1.06; 95% CI: 1.02;1.11), number of co-morbidities (OR=1.44; 95% CI: 1.12;1.69), Charlson co-morbidity index (OR=6.67; 95% CI: 2.98;22.16) and time to surgery (OR=1.04; 95% CI: 1.02;1.07).

CONCLUSIONS

Number of co-morbidities and Charlson co-morbidity index helped predicting the mortality rate.

Hip fractures in nonagenarians: perioperative mortality and survival

The nonagenarian population is increasing yet there is little known about their survival and mortality rates following hip fractures. The aim was to review and evaluate all the nonagenarians who underwent surgery for intra- or extracapsular hip fracture at the Trauma Unit of the Department of Surgery at the Academic Medical Center (AMC) in Amsterdam in the past 20 years. In this retrospective study, 155 nonagenarians sustaining hip fractures between 1982 and 2001 were included and reviewed. In this population there were 128 women (83%) and 27 men (17%). Mortality in women was higher than in men. In men more intracapsular fractures (70%) were diagnosed compared to extracapsular fractures. The opposite, 38% intracapsular and 62% extracapsular fractures were found in women (p=0.002). A trend in higher perioperative mortality for extracapsular fractures and increasing ASA-classification was observed. Mean survival for the whole population, men and women was 756, 544 and 787 days, respectively. This study shows that ASA-II nonagenarians with hip fractures have comparable life expectancy compared to nonagenarians without a hip fracture. Shortening of hospital stay after hip fracture surgery reduces the costs and will benefit the patient.

Hip fractures in nonagenarians--a study on operative and non-operative management

Hip fractures in nonagenarians represent a special group because of their advanced age and co-morbidities. Surgery is advocated for their younger counterparts but may not appear desirable in nonagenarians. Eighty-four patients were studied over a 2-year period. There were 73 female and 11 male patients. Forty-seven patients sustained an intertrochanteric fracture of the femur. 37 suffered a neck of femur fracture. ASA score of II was the largest group with 51. At least 62 had one co-morbidity or more; 46 were considered demented with a mental test score of less than 7. The mean length of stay was 31 days. Treatment consisted of either traction or surgery. Forty-six patients were managed surgically and 38 non-surgically. Patient review was done 2 years after the fracture. The overall rate of complications was 52% for the operative and non-operative groups. Death outcome at 24 months was not significantly affected by ASA status, number of co-morbidities at admission, or between surgical and non-surgical treatment. However, there was statistical significance between death and the mini-mental test score of less than 7 (P < 0.05). Forty-three patients were still alive after 2 years; of which 27 had been treated surgically and 16 non-surgically. The overall mortality in both operative and non-operative groups is 49%. Surgery significantly increases the ability for independent ambulation (P < 0.01). Therefore the outcome of non-operative and non-operative treatment in nonagenarians with hip fractures is poor due to the high rates of mortality and morbidity.

Estudo da mortalidade na fratura do fêmur proximal em idosos

Foi feito um estudo de revisão sobre a mortalidade na fratura do fêmur proximal em idosos com base nas publicações mais relevantes do período de 1998 a 2002. Foram incluídos 25 artigos relacionados ao assunto, selecionados com base nos bancos de dados Medline e Cochrane, totalizando 24.062 pacientes com mais de 60 anos de idade, que tiveram fratura do fêmur proximal. Quatorze estudos foram prospectivos, oito retrospectivos e três revisões sistemáticas. As taxas médias de mortalidade foram de 5,5% durante a internação hospitalar, 4,7% ao fim de um mês de seguimento, 11,9% com três meses, 10,8% com seis meses, 19,2% com um ano e 24,9% com dois anos. Foram identificados quatro fatores intimamente relacionados com uma maior mortalidade nestes pacientes: idade avançada, grande número de doenças associadas, sexo masculino e presença de deficiências cognitivas. Outros fatores mostraram uma fraca correlação com a mortalidade como capacidade deambulatória prévia, índice de risco anestésico da Sociedade Americana de Anestesia (ASA), anemia, hipoalbuminemia, linfopenia e existência de AVC prévio. Os fatores como tempo prévio à cirurgia, tipo de anestesia utilizada e tipo de osteossíntese empregada não mostraram ter interferência.

Hip fractures in centenarians

The centenarian population is increasing yet there is little about their morbidity and mortality rates following hip fracture. The aim was to review centenarians treated for proximal femoral fractures in Edinburgh describing treatment outcomes in relation to mortality, walking ability and residential status comparing centenarians with a the more typical hip fracture population. In this retrospective review, 18 centenarians sustaining hip fractures in Edinburgh between 1998 and 2002 were compared to 18 randomly selected "normal" hip fracture patients aged 75-83 years. Centenarian in-hospital, 1 and 4 month mortality was 11.1, 33.3 and 50%, respectively, versus 0, 0 and 5.6% in the normal group. Centenarian 4 month mortality was significantly greater than that of the normal group (Fisher's Exact Test, P = 0.00723). A total of 22.2% of centenarians regained pre-fracture walking ability compared to 58.8% of the normal patients. A total 28.6% of centenarians could continue living independently post-fracture compared to 69.2% of the normal group.

Nonagenarians on a rehabilitation unit: characteristics, progress, and outcomes

OBJECTIVE

To determine the diagnostic, functional, and demographic characteristics and to review the progress of nonagenarians admitted to a general rehabilitation unit. In addition, to compare their outcomes with a selected group of younger patients.

DESIGN

A 4-yr retrospective chart review of the 40 admitted nonagenarians. Functional status was assessed by means of the FIM instrument.

RESULTS

The most common diagnostic category was hip or femur fracture. Only two of the 40 patients required a transfer back to an acute medical unit. Mean FIM gain was 14.42 points. Nineteen of the 40 patients were discharged directly to their homes. Discharge home was related to younger age, living situation before hospitalization, and whether the patient lived alone or with others prehospitalization. No admission FIM score was related to discharge disposition. Compared with younger hip or femur fracture patients, nonagenarians were more likely to be women, be unmarried, not lived at home before admission, and less likely to be discharged home.

CONCLUSION

The majority of this select group of nonagenarians was able to complete a structured program on a rehabilitation unit. Their demographic and functional characteristics and long-term outcomes merit further study.