Key result
Surgery within 72 hours for hip fracture in patients over 85 was significantly associated with a lower 30-day mortality rate compared to surgery after 72 hours (3.2% vs 6.9%, OR 0.449).
Why the study?
The study assessed whether early surgery and other clinical and orthogeriatric parameters affect mortality in hip fracture patients aged over 85.
Does early surgery within 72 hours reduce mortality in hip fracture patients over 85 years old?
Cohort (n=941)
No
Does early surgery within 72 hours reduce mortality in hip fracture patients over 85 years old?
Odds Ratio: 0.449 (95% CI 0.241–0.835)
Absolute Event Rate: 3.2% vs 6.9%
p-value: p=0.011
In hip fracture patients over 85, performing surgery within 72 hours allows for medical optimization while maintaining significantly lower intra-hospital and 30-day mortality rates.
Supports expedited surgery within 72 hours in patients >85; leaves open need for randomized confirmation before practice change.
AIM: Aim of the study was to assess whether early surgery and other clinical and orthogeriatric parameters could affect mortality rate in hip fracture patients aged > 85. MATERIALS AND METHODS: Data regarding a 42-month period were retrospectively obtained from the institutional medical records and registry data. Gender, age, fracture pattern, surgical technique, type of anesthesia, timing of surgical intervention (within 24, 48 or 72 h from admission), days of hospitalization, mortality rate divided in intra-hospital, at 30 days and at 1 year were collected for the whole population. Some additional data were collected for an orthogeriatric subgroup. RESULTS: 941 patients were considered, with a mean age of 89 years. Surgery was performed within 24, 48 and 72 h in 24.4%, 54.5% and 66.1% of cases, respectively. Intra-hospital mortality rate resulted to be 3.4%, while mortality at 30 days and 1 year resulted to be 4.5% and 31%, respectively. Early surgery within 48 and 72 h were significantly associated with a lower intra-hospital and 30-day mortality rate. In the orthogeriatric subgroup (394 patients), a significant association with a higher mortality rate was found for general anesthesia, number of comorbidities, ADL (Activities of Daily Living) < 3, transfer to other departments. CONCLUSIONS: In over-85 hip fracture patients, the threshold for early surgery might be moved to 72 h to allow patients pre-operative stabilization and medical optimization as intra-hospital and 30-day mortality rates remain significantly lower. Advanced age, male sex, number of comorbidities, pre-operative dependency in ADL, general anesthesia, length of hospitalization and transfer to other departments were significantly related to mortality rate.
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Luca et al. (2022) conducted a cohort in Proximal femur fracture (hip fracture) (n=941). Surgery within 72 hours vs. Surgery after 72 hours was evaluated on 30-day mortality (OR 0.449, 95% CI 0.241-0.835, p=0.011). Surgery within 72 hours for hip fracture in patients over 85 was significantly associated with a lower 30-day mortality rate compared to surgery after 72 hours (3.2% vs 6.9%, OR 0.449).
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