Increased age is not associated with higher incidence of complications, longer stay in acute care hospital and in hospital mortality in geriatric hip fracture patients
Introduction
The number of individuals at extreme old age is predicted to increase dramatically over the next decade [1]. Hip-related fractures are typical geriatric fractures. As shown in several studies, substantial femoral bone loss continues throughout the old age, followed by an exponential increase in the risk of hip fracture [2], [3]. Although osteoporosis plays a prominent role in the pathogenesis, there are many more factors of impact like atrophia of the musculoskeletal system, insecurity in coordination and walking and loss of sensorial skills [4].
In 2008, nearly 140,000 fractures (ICD 10 S.72.0–72.2) were registered in Germany [5]. These injuries display one of the most serious healthcare problems affecting the elderly, contributing to estimated costs of 2–4 billion euros per year in Germany [6]. Due to demographic transition, global incidence of hip related fracture is increasing [7], [8], [9].
Hip-related fractures are typically followed by a large number of peri- and postoperative complications. Specifically, the amount of outpatient care significantly rises after a femur fracture [10].
Most patients with fractures of the proximal femur are in the 8th decade. Until age 85, 11% of women and 5% of men are hospitalized because of femoral fractures [11]. Mortality in this cohort, compared to people the same age without fracture, is increased by 1.15–1.20 [4].
Considering that age-related mortality in patients >90 years is near 50%, the risk of suffering femoral fracture does not seem high. Literature addressing the outcomes of patients in the 10th decade is limited. The Scottish Hip Fracture Audit, a prospective, national, multicenter study, showed an age-related decrease of survival and favorable outcomes after surgery for the treatment of a hip fracture [12].
The present study was conducted to prove if patients in the 10th decade with hip-related fractures are disadvantaged according to incidence and type of complications, length of ICU stay, possible readmission to ICU, length of in-hospital stay, and short-term mortality.
Section snippets
Patients and methods
402 patients of at least 60 years old with proximal femoral fractures (ICD 10 S.72.0–72.2) were included in this prospective single center observational study. Criteria for exclusion were multiple traumas (injury severity score ≥16) and malignoma-associated fracture. All patients were surgically treated either with osteosynthesis or hip arthroplasty. The inclusion period lasted from the 1st of April 2009 to the 30th of September 2011. Approval from the University of Marburg's Ethics Committee
Results
In the observational period we were able to include 402 patients. 293 (73%) were females and 109 (27%) were males. The average age of patients was 81.4 years (range 60–99).
Examined cohorts showed 85 patients between 60 and 74 years, 253 patients from 75 to 90 years old, and 64 patients over 90 years with a ratio (f:m) of 2.7:1.
Further baseline data is shown in Table 1. Time from admission to operative treatment showed no statistically significant difference. The in-hospital period was similar,
Discussion
The aim of the present study was to prove if extremely old patients suffering hip-related fracture are severely endangered according to the incidence of complications, length of ICU and in-hospital stay, and short-term mortality.
Cognitive impairment increased with age, and >90 year old patients had significant lower BMI levels compared to the middle-aged cohort. Patients in very advanced age showed neither significantly higher percentage of diagnosed osteoporosis (p = 0.171), nor significantly
Contributors
All authors declare that they participated in the collection of data, analysis and interpretation, and writing of the manuscript and that they have approved the final version.
Competing interest
All authors declare that they have no competing interests.
Funding
There was no funding for this study.
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