Key result
In nonagenarians undergoing hip fracture repair, the absence of congestive heart failure and chronic pulmonary disease was associated with 91% (p=0.036) and 86% (p=0.05) lower in-hospital mortality hazards.
Why the study?
Do specific comorbidities or the Deyo score predict mortality in nonagenarians following surgical repair of hip fractures?
Observational (n=39)
Do specific comorbidities or the Deyo score predict mortality in nonagenarians following surgical repair of hip fractures?
Preexisting congestive heart failure, chronic pulmonary disease, and dementia are significant predictors of mortality in nonagenarians following hip fracture surgery, whereas the Deyo score is not.
May aid risk stratification by CHF/CPD in nonagenarian hip fracture repair; leaves open whether optimization improves outcomes.
BACKGROUND: The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality. METHODS: Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery. RESULTS: Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036). CONCLUSIONS: Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.
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Fansa et al. (2016) conducted an observational in Hip fracture (n=39). Preexisting comorbidities (CHF, CPD, dementia) vs. Patients without these comorbidities was evaluated on In-hospital mortality (91% lower hazard, p=0.036). In nonagenarians undergoing hip fracture repair, the absence of congestive heart failure and chronic pulmonary disease was associated with 91% (p=0.036) and 86% (p=0.05) lower in-hospital mortality hazards.
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