Predictors for Adverse Outcome in Patients Aged 80 Years and Older Undergoing Emergent Hip Surgery

Background: Increased life expectancy results in aging of the population. One of the leading medical problems of elderly patients is hip fracture. We studied demographic, surgical and anesthetic parameters of elderly patients who underwent surgery due to osteoporotic hip fracture, to find predictors for peri-operative morbidity and mortality. Methods: This is a retrospective review of prospectively collected data of patients aged 80 years and older who underwent emergent surgery due to osteoporotic femoral neck, subcapital or pertrochanteric fractures. Data was collected on age, gender, co-morbidities, American Society of Anesthesiologists Class, number of regular medications, whether the patient was bedridden or not before the surgery, hemoglobin on admission and on discharge, type of surgery and anesthesia, duration of surgery, duration of hospitalization, post-operative morbidity and mortality. The demographic and peri-operative parameters were analyzed and matched to the post-operative complications and mortality to find predictors for adverse outcome. Results: One hundred and nine patients were included in the study, of whom 22 (20%) had post-operative complications and 10 (9.1%) died. We found an increased complication rate in patients who had chronic obstructive pulmonary disease and in patients who underwent general anesthesia. Patients who were bedridden before the surgery had increased mortality rates. No significant correlation was found between outcome and any other factors. Conclusion: Our results suggest favoring regional anesthesia in elderly patients undergoing emergent femoral neck surgery and acknowledging a higher risk in chronic pulmonary disease or bedridden patients.