What is the clinical evidence from this study?

Study design: Cohort. Population: Hip fracture (n=298). Intervention: Operative management vs. Non-operative management. Primary outcome: All-cause mortality (OR 0.39, 95% CI 0.19-0.82, p=0.013).

April 23, 2026Open Access

Association Between Non-Operative versus Operative Management and Mortality in Elderly Patients with Hip Fracture: A Retrospective Cohort Study

Key Result

Operative management reduced 1-year mortality risk by 61% (OR 0.39) compared to non-operative management in elderly patients with hip fractures.

Key Points

This study aims to compare mortality outcomes between non-operative and operative management of hip fractures in elderly patients.
Analyzed data from 298 elderly patients with hip fractures over five years.
Used multivariable logistic regression to adjust for factors such as age, gender, and comorbidities.
Conducted subgroup analyses based on age.
The 1-year mortality rate was 14.43%, with higher rates in the non-operative group (25.42%).
Surgical management was associated with a 61% reduction in mortality risk.
Significant benefits of surgical management were noted in patients under 80 years.

Study Design

Type

Cohort (n=298)

Multicenter

Structured PICO

Does operative management reduce all-cause mortality in elderly patients with hip fractures compared to non-operative management?

Population

298 elderly patients (>65 years) with acute hip fractures (femoral neck, pertrochanteric, subtrochanteric), mean age 78.5, 62.1% female, from a single center in China.

Intervention

Operative management (hip arthroplasty or open reduction internal fixation)

Comparator

Non-operative management (bed rest, analgesia, prophylaxis, traction, rehabilitation)

Outcome

All-cause mortality following hip fracture diagnosishard clinical

Operative management of hip fractures in elderly patients is associated with a significantly reduced risk of mortality, particularly in those under 80 years of age.

Main Result

Effect estimate: OR 0.39 (95% CI 0.19-0.82)

Absolute Event Rate: 11.72% vs 25.42%

p-value: p=0.013

Limitations

Potential residual confounding as non-surgical patients were presumably frailer in unmeasured domains
Limited generalizability to younger patients or those with other fracture patterns
Did not perform subgroup analyses based on specific surgical approach
Post hoc power analysis indicated only 72.9% power due to sample size constraints

Abstract

Objective: To compare outcomes between non-operative and operative management of hip fractures in elderly patients. Methods: In this single-center retrospective cohort study (January 2018–December 2022), we enrolled 298 elderly patients with hip fractures after excluding 704 from an initial 1,002 consecutive cases. This study excluded patients with old fractures, other types of fractures, lack of data on injury reason, and absence of follow-up data. Multivariable logistic regression was used to explore the association between different treatment and mortality, adjusting for age, gender, injury reason, fracture type, hypertension, and diabetes. Subgroup analyses were employed to assess the association between the different treatments and mortality. Results: Among the 298 elderly patients with hip fractures, 59 were managed non-operatively and 239 underwent surgery. The overall 1-year mortality rate was 14.43% (43/298). Mortality was 25.42% (15/59) in the non-operative group and 11.72% (28/239) in the operative group. After adjustment, surgical management reduced mortality risk by 61% (OR =0.39, 95% CI:0.19– 0.82, P = 0.013). Subgroup analysis demonstrated significant benefit in patients < 80 years (87% risk reduction; OR = 0.13, 95% CI: 0.04– 042), whereas no significant association was observed in ≥ 80-year-olds (OR = 0.85, 95% CI:0.32– 2.80, P for interaction = 0.023). Conclusion: Our analysis indicates an association between operative management and reduced mortality risk in elderly hip fracture patients. This benefit was observed to be more marked in individuals aged under 80 years. While consistent with existing observational studies, these findings merit confirmation through randmised controlled trials, particularly to determine optimal management strategies for the oldest old (≥ 80 years). Keywords: hip fracture, operation, mortality, cohort study, elderly

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