Surgical Outcome Following Hip Fracture in Patients > 100 Years Old: Will They Ever Walk Again?

Introduction: Advances in medicine have led to a growth in the centenarian population (>100 years old). Centenarians are a largely unstudied population but as longevity increases, so will the cost of providing care for this group. Methods: One hundred and ten patients were admitted to SBMC 195 times between 2000 and 2009. Thirteen patients were treated for hip fracture. Data abstracted from the charts of these patients including age, gender, ethnicity, co-morbidities, advance directives (ADRs), functional status, length of stay (LOS), pre-operative and post-operative residential status and ambulatory status, ASA grade, type of anesthesia, duration of surgery and for complications of surgery or anesthesia. Results: The mean age was 101.2 years (100 to 104 years) with an M:F ratio of 2:11. The most common co-morbidities were hypertension, anemia, congestive heart failure (CHF) and coronary artery disease. Among the 13 patients with hip fractures, 12 had operative intervention while one was treated conservatively. The mean ASA grade was 2.75 (1 - 4). Five patients had surgery under general anesthesia and seven received spinal anesthesia. Five patients received a bi-polar hip replacement and seven patients underwent internal fixation. The mean operative time was 47.6 min (27 - 90 min). Five (41.7%) patients required a peri-operative blood transfusion. The mean post-anesthesia recovery score was 9.42 (9 - 10). All patients, except two, were returned to their pre-operative ambulatory status. Advanced directives were held by only 30.8% of patients on admission. There were 2 post-operative morbidities and 1 mortality. Conclusions: Centenarians represent a high-risk-surgical population due to their age and associated comorbidities. Hip fracture is the cause of >10% of all admissions and accounts for 29% of all surgical procedures in this age group. Despite their age and comorbidities, surgery for hip fracture is well tolerated and nearly all patients were returned to their pre-hospital ambulatory status. Education on advanced directives is lacking.