Study on factors affecting mortality in nonagenarian patients in orthopaedic surgery
DOI:
https://doi.org/10.18203/2320-6012.ijrms20190945Keywords:
Fracture, Mortality, NonagenarianAbstract
Background: With medicine advancing, population is aging in the world. We encounter elderly patients in operating rooms more often. In this study, the aim was to investigate mortality and morbidity rates of patients 90 years of age or older within 1 year from the date of operation due to fractures.
Methods: The study was performed retrospectively in the 3rd stage health institution. All patients that had fracture operation in the operating rooms of the orthopaedics department between 2011 and 2017 and that were 90 years or older on the day of operation were included in the study. Patients who were operated twice were excluded from the study.
Results: Around 83 patients of which were included in the study. The mean age of the patients was 92.89±2.84. In-hospital mortality rate was 8.4%. The mortality rate within 3 months from the operation was 18.1%, 25.3% within 1 year, and 61.4% within 5 years or above. Author found that the mean survival period for the total of the surviving patients was 23.87±18.96 months. Author found that there was a meaningful causation between morbidity developing post-operation and in-hospital mortality, 3-month mortality, and 1-year mortality (p<0.05).
Conclusions: Author think that it was important to recognize the fact that despite being more vulnerable, patients 90 years of age or older have a significant life expectancy post-hospital discharge. Author think that post-operation acute morbidity affects mortality rates and it was important to avoid factors that may cause acute morbidity in patients 90 years of age and older.
References
Miller AG, Bercik MJ, Ong A. Nonagenarian hip fracture: treatment and complications. J Trauma Acute Care Surg. 2012 May;72(5):1411-5.
Formiga F, Lopez-Soto A, Sacanella E, Coscojuela A, Suso S, Pujol R. Mortality and morbidity in nonagenarian patients following hip fracture surgery. Gerontology. 2003;49:41-5.
Deakin DE, Boulton C, Moran CG. Mortality and causes of death among patients with isolated limb and pelvis fractures. Injury. 2007;38:312-7.
Bombaci H, Erdoğan Ö, Çetinkaya F, Kuyumcu M, Kaya E, Bombaci E. Preoperative indicators affecting postoperative mortality in elderly patients with hip fractures. Acta Orthop Traumatol Tur. 2012;46(6):425-9.
Axelsson KF, Wallander M, Johansson H, Lundh D, Lorentzon M. Hip fracture risk and safety with alendronate treatment in the oldest-old. J Intern Med. 2017 Dec;282(6):546-59.
Sambrook P, Cooper C. Osteoporosis. Lancet. 2006;367:2010-8.
Johnell O, Kanis JA, Jonsson B, Oden A, Johansson H, De Laet C. The burden of hospitalised fractures in Sweden. Osteoporos Int. 2005;16:222-8.
Fansa A, Huff S, Ebraheim N. Prediction of mortality in nonagenarians following the surgical repair of hip fractures. Clin Orthop Surg. 2016;8(2):140-5.
Lin WT, Chao CM, Liu HC, Li YJ, Lee WJ, Lai CC. Short term outcomes of hip fractures in patients aged 90 years old and over receiving surgical intervention. PLoS One. 2015;10(5):e0125496
Hagino T, Maekawa S, Sato E, Bando K, Hamada Y. Prognosis of proximal femoral fracture in patients aged 90 years and older. J Orthop Surg (Hong Kong). 2006;14(2):122-6.
Kruczynski J, Gorska J, Futyma J, Zurawski R, Banach W. Results of operative treatment of hip fractures in patients over 90. Ortop Traumatol Rehabil. 2008;10(4):338-49.
Berend ME, Thong AE, Faris GW, Newbern G, Pierson JL, Ritter MA. Total joint arthroplasty in the extremely elderly hip and knee arthroplasty after entering the 89th year of life. J Arthroplasty. 2003;18(7):817-21.
Pagnano MW, McLamb LA, Trousdale RT. Primary and revision total hip arthroplasty for patients 90 years of age and older. Mayo Clin Proc. 2003;78(3):285-8.
Tay YW, Hong CC, Murphy D. Functional outcome and mortality in nonagenarians following hip fracture surgery. Arch Orthop Trauma Surg. 2014 Jun;134(6):765-72.
Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331(7529):1374.
Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Orthop Trauma. 1987;1(4):298-305.
Shah M, Aharonoff G, Wolinsky P Zuckerman JD, Koval KJ. Outcome after hip fracture in individuals ninety years of age and older. J Orthop Trauma. 2001;15:34-9.
Jennings AG, Boer P. Should we operate on nonagenarians with hip fractures? Injury. 1999;30:169-72.
Öztürk I, Toker S, Ertürer E, Aksoy B, Seçkin F. Analysis of risk factors affecting mortality in elderly patients (aged over 65 years) operated on for hip fractures. Acta Orthop Traumatol Tur. 2008;42:16-21.
Vochteloo AJ, Borger van der Burg BL, Tuinebreijer WE, de Vries MR, Niggebrugge AH, Bloem RM, et al. Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients? Geriatr Gerontol Int. 2013 Jan;13(1):190-7.