In-Hospital Mortality following Proximal Femur Fractures in Elderly Population
19 February 2019
22 May 2019
16 July 2019 (online)
Context In India, hip fracture crude incidence above the age of 50 years was 129 per 100,000.
Aims The aim of this study is to analyze the in-hospital mortality following proximal femur fractures in elderly Indian population.
Methods and Material The study was done in Sri Ramachandra Medical Center, Chennai, India. Patient's records were retrospectively evaluated for a period of 3 years from January 1, 2015 to January 1, 2018. The inclusion criteria were patients both male and female aged more than 65 years admitted with the diagnosis of neck of femur or intertrochanteric or subtrochanteric fractures. The exclusion criteria were patients having any associated fracture or previous hip fracture history or diagnosed primary or secondary malignancies. To evaluate any surgical delay two groups were formed. After eliminating cases based on exclusion criteria, we had 270 patients for evaluation.
Statistical Analysis Used The collected data were analyzed with IBM.SPSS statistics software 23.0 Version. To describe about the data descriptive statistics frequency analysis, percentage analysis were used for categorical variables and the mean and standard deviation (SD) were used for continuous variables. To find the significant difference between the bivariate samples, Student's t-test and analysis of variance (ANOVA) were used. The p-value of 0.05 is considered as significant level.
Results We had a total of 24 mortalities with 15 males and 9 females. The in-hospital mortality of patients who underwent replacement surgeries for proximal femur fractures was 14 in our study. Sixteen of the in-hospital mortality patients had low Parker's mobility score. Twenty patients had mortality when surgery was delayed more than 48 hours.
Conclusions In-hospital mortality in elderly patients having proximal femur fracture increases significantly if the patient was having low-preoperative mobility status, if surgery was delayed more than 48 hours, and if patient undergoes replacement surgeries.
- 1 Daniachi D, Netto AdosS, Ono NK, Guimarães RP, Polesello GC, Honda EK. Epidemiology of fractures of the proximal third of the femur in elderly patients. Rev Bras Ortop 2015; 50 (04) 371-377
- 2 Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003; 51 (03) 364-370
- 3 Filipov O. Epidemiology and social burden of the femoral neck fractures. J IMAB. 2014; 20 (04) 516-518
- 4 Kanis JA, Johnell O, Oden A. , et al. Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 2000; 11 (08) 669-674
- 5 Somersalo A, Paloneva J, Kautiainen H, LÖNnroos E, HEinÄNen M, Kiviranta I. Increased mortality after lower extremity fractures in patients <65 years of age. Acta Orthop 2016; 87 (06) 622-625
- 6 Dhanwal DK, Siwach R, Dixit V, Mithal A, Jameson K, Cooper C. Incidence of hip fracture in Rohtak district, North India. Arch Osteoporos 2013; 8 (1–2): 135
- 7 Singh S, Bajorek B. Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy. Pharm Pract (Granada) 2014; 12 (04) 489
- 8 Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. [Reviewing the definition of elderly]. Nippon Ronen Igakkai Zasshi 2006; 43 (01) 27-34
- 9 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (05) 373-383
- 10 Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 2010; 1 (01) 6-14
- 11 Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 1997; 87 (03) 398-403
- 12 Bentler SE, Liu L, Obrizan M. , et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009; 170 (10) 1290-1299
- 13 Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV. Risk factors for in-hospital post-hip fracture mortality. Bone 2011; 49 (03) 553-558
- 14 Orces CH. In-hospital hip fracture mortality trends in older adults: the National Hospital Discharge Survey, 1988-2007. J Am Geriatr Soc 2013; 61 (12) 2248-2249
- 15 Wu TY, Jen MH, Bottle A, Liaw CK, Aylin P, Majeed A. Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study. J Public Health (Oxf) 2011; 33 (02) 284-291
- 16 Alzahrani K, Gandhi R, Davis A, Mahomed N. In-hospital mortality following hip fracture care in southern Ontario. Can J Surg 2010; 53 (05) 294-298
- 17 Saudan M, Lübbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P. Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 2002; 16 (06) 386-393
- 18 Utrilla AL, Reig JS, Muñoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma 2005; 19 (04) 229-233
- 19 Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev 2006; (04) CD001708
- 20 Sathiyakumar V, Greenberg SE, Molina CS, Thakore RV, Obremskey WT, Sethi MK. Hip fractures are risky business: an analysis of the NSQIP data. Injury 2015; 46 (04) 703-708
- 21 Scottish Intercollegiate Guidelines Network (SIGN). Management of elderly people with fractured hip. Edinburgh: SIGN; 1997. . (SIGN publication no. 15). Accessed 21 May 2009
- 22 Smektala R, Endres HG, Dasch B. , et al. The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord 2008; 9: 171
- 23 Franzo A, Francescutti C, Simon G. Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 2005; 20 (12) 985-991
- 24 Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important?. J Bone Joint Surg Am 2005; 87 (03) 483-489
- 25 Castronuovo E, Pezzotti P, Franzo A, Di Lallo D, Guasticchi G. Early and late mortality in elderly patients after hip fracture: a cohort study using administrative health databases in the Lazio region, Italy. BMC Geriatr 2011; 11: 37-43