Factors Influencing Geriatric Orthopaedic Trauma Mortality

• Published in: Injury 2022-03, Vol.53 (3), p.919-924
• Main Authors: Mun, Frederick, Ringenbach, Kathy, Baer, Blake, Pradhan, Sandeep, Jardine, Kayla, Chinchilli, Vernon M., Andreae, Michael H., Boateng, Henry
• Format: Article
• Language: English
• Subjects: Aged; Geriatric orthopaedics; Humans; Injury Severity Score; Intensive Care Units; Length of Stay; Mortality; Multiple Trauma; Orthopaedic surgery; Orthopaedic trauma; Orthopedics; Retrospective Studies; Survival; Trauma; Wounds and Injuries - therapy
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.01.005

•An ISS > 30 was independently associated with and predictive of a lower survival probability amongst geriatric orthopaedic trauma patients.•Genitourinary disease was associated with increased mortality amongst geriatric orthopaedic trauma patients.•Increased age, ICU stay, MODS, and anticoagulant use were significantly predictive of mortality 1 and 6-months post-ICU admission.•Relative risk for mortality in the first month was significantly associated with high-energy traumas and psychiatric disease.•The number of orthopaedic surgeries, number of orthopaedic injuries, and type of orthopaedic injury were not found to be predictive of survival. This study aimed to: (1) evaluate the independent risk factors related to survival and mortality and (2) predict survival in geriatric orthopaedic trauma patients admitted to our institution's ICU as a Level 1 or 2 trauma activation. A retrospective review was performed on patients age >60, over a 10 year period, who were involved in a multi-trauma with orthopaedic injuries. Variables evaluated include: sex, age, Injury Severity Score (ISS), mechanism of injury, number and type of orthopaedic injury, anticoagulant use, comorbidities, length of stay in intensive care unit (ICU), type of ICU, ventilator use, vasopressors use, incidence of multiple organ dysfunction syndrome (MODS), number of surgeries, and 1-month and 6-month mortality. A Kaplan-Meier estimator and Cox proportional hazards analysis were used to predict and assess survival probability. 174 patients were included, with an average mortality of 47.7%. Deceased patients had a significantly greater age, ISS, vasopressor usage, ICU stay, incidence of MODF, incidence of genitourinary disease, anticoagulant usage, ventilator usage, number of orthopaedic surgeries, and orthopaedic injuries. The relative risk for mortality within the first month was significantly associated with increased age, ISS, high-energy trauma, length of ICU stay, MODS, psychiatric disease, and anticoagulant use. Patients with an ISS ≤30 were significantly more likely to survive than patients with an ISS of >30. Greater age, ISS, length of ICU stay, incidence of MODS, anticoagulant, and ventilator use were significantly predictive of lower survival rates. Mechanism of injury, number of orthopaedic surgeries and orthopaedic injuries, and type of orthopaedic injury were not found to be predictive of survival. An ISS >30 at admission is strongly predictive of a lower probability of survival.