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

• Published in: The Journal of arthroplasty 2020-05, Vol.35 (5), p.1186-1193
• Main Authors: Mayordomo-Cava, Jennifer, Abásolo, Lydia, Montero-Fernandez, Nuria, Ortiz-Alonso, Javier, Vidán-Astiz, Maite, Serra-Rexach, José Antonio
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Female; hip fracture; Hip Fractures - surgery; Humans; nonagenarians; postoperative complications; Retrospective Studies; Risk Factors; short-term mortality; treatable risk factors; Treatment Outcome
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2019.12.044

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. 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. 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. 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.