Ahmet ASLAN, Tolga ATAY, Nevres Hürriyet AYDOĞAN

Risk factors for mortality and survival rates in elderly patients undergoing hemiarthroplasty for hip fracture

Objective: The aim of this study was to analyze the relationship between mortality and possible risk factors in elderly patients surgically treated with hemiarthroplasty for hip fracture and to determine mortality rates and yearly survival outcome in a selected cohort. Methods: A total of 92 patients (51 men (55.4%) and 41 women (44.6%); mean age: 76.47 years) who underwent hemiarthroplasty for hip fracture were included into the study. The following data associated with risk factors were recorded for 92 patients: age, gender, pre-fracture activities of daily living (ADL), type of fracture, American Society of Anesthesiologists (ASA) score, therapeutic procedure, type of anesthesia, length of time after fracture until operation, postoperative mobility, and duration of hospitalization. A multivariate logistic regression test was used to evaluate the correlation between the risk factors and first- and second-year mortality rates. Third-year mortality rate after surgery was analyzed and compared with the general mortality rate in a similar population of the same age group living in the same city. Results: The mortality rate was 18.5% (17 patients) after the first-year follow-up and 25% (23 patients) after the second year. The mortality risk after hip fracture was found to be 11.7 times greater than the similar age group population in the third year. In addition, there was a significant relationship between a low (dependent) preoperative ADL score, advanced age (>80 years), male gender, high ASA score and poor ability to walk (unable to walk), and first- and second-year mortalities (p0.05). Conclusion: Advanced age, male gender, a high ASA score, a dependent preoperative ADL score, and a postoperative inability to walk were determined to be the most important risk factors affecting mortality in elderly patients with hip fracture. The mortality risk was 11.7 times greater than that of a population with similar characteristics.

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1. Beloosesky Y, Weiss A, Grinblat J, Brill S, Hershkovitz A. Can functional status, after rehabilitation, independently predict long-term mortality of hip-fractured elderly patients? Aging Clin Exp Res 2004; 16: 44-8. [CrossRef]

2. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: Prospective observational cohort study. BMJ 2005; 331: 1374. [CrossRef]

3. Koval KJ, Skovron ML, Aharonoff GB, et al. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop 1998; 348: 22-8. [CrossRef]

4. Endo Y, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ. Gender differences in patients with hip fracture: A greater risk of morbidity and mortality in men. J Orthop Trauma 2005; 19: 29-35. [CrossRef]

5. Sofu H, Üçpunar H, Çamurcu Y, et al. Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture. Ulus Travma Acil Cerrahi Derg 2017; 23: 245-50 [CrossRef]

6. Camurcu Y, Cobden A, Sofu H, Saklavci N, Kis M. What are the determinants of mortality after cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients? J Arthroplasty 2017; 32: 3038-43. [CrossRef]

7. Diamantopoulos AP, Hoff M, Skoie IM, Hochberg M, Haugeberg G. Short- and long-term mortality in males and females with fragility hip fracture in Norway. A population-based study. Clin Interv Aging 2013; 8: 817-23. [CrossRef]

8. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 2010; 39: 203-9. [CrossRef]

9. Ireland AW, Kelly PJ, Cumming RG. Risk factor profiles for early and delayed mortality after hip fracture: Analyses of linked Australian Department of Veterans’ Affairs databases. Injury 2015; 46: 1028-35. [CrossRef]

10. Jiang J, Yang CH, Lin Q, Yun XD, Xia YY. Does arthroplasty provide better outcomes than internal fixation at mid- and long-term followup? A meta-analysis. Clin Orthop Relat Res 2015; 473: 2672-9. [CrossRef]

11. Härstedt M, Rogmark C, Sutton R, Melander O, Fedorowski A. Impact of comorbidity on 6-month hospital readmission and mortality after hip fracture surgery. Injury 2015; 46: 713-8. [CrossRef]

12. Atay T, Ceylan BG, Özmeriç A, et al. The effects of related factors on one- and two-year mortality after a hip fracture in elderly turkish patients. Balkan Med J 2010; 27: 127-31.

13. Şener M, Onar V, Kazımoğlu C, Yağdı S. Mortality and morbidity in elderly patients who underwent partial prosthesis replacement for proximal femoral fractures. Eklem Hastalik Cerrahisi 2009; 20: 11-7.

14. Haentjens P, Magaziner J, Colón-Emeric CS, et al. Meta-analysis: Excess mortality after hip fracture among olderwomen and men. Ann Intern Med 2010; 152: 380-90. [CrossRef]

15. Johansen A, Mansor M, Beck S, Mahoney H, Thomas S. Outcome following hip fracture: Post-discharge residence and long-term mortality. Age Ageing 2010; 39: 653-6. [CrossRef]

16. Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963; 185: 914-9. [CrossRef]

17. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996; 77: 217-22. [CrossRef]

18. Beaupre LA, Cinats JG, Senthilselvan A, et al. Does standardized rehabilitation and discharge planning improve functional recovery in elderly patients with hip fracture? Arch Phys Med Rehabil 2005; 86: 2231-9. [CrossRef]

19. Address Based Population Registration System Population Census 2007, Turkish Statistical Institute Publication Number: 3124, January 2008, Ankara. ISBN: 978-975-19-4205-0 and Death Statistics 2007, Province and District Centers, Turkish Statistical Institute Publication Number:3208, January 2009, Ankara. ISBN: 978-975-19-4419-1.

20. Oztürk I, Toker S, Ertürer E, Aksoy B, Seçkin F. Analysis of risk factors affecting mortality in elderly patients (aged over 65 years) operated on for hip fractures. Acta Orthop Traumatol Turc 2008; 42: 16-21. [CrossRef]

21. Çetinkaya E, Yavuz U, Lapçin O, et al. Assessment of peroperative parameters affecting mortality in geriatric hip fractures. JAREM 2016; 6: 183-7 [CrossRef]

22. van den Bekerom MP, Sierevelt IN, Bonke H, Raaymakers EL. The natural history of the hemiarthroplasty for displaced intracapsular femoral neck fractures. Acta Orthop 2013; 84: 555-60. [CrossRef]

23. Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: A systematic review and meta-analysis. Injury 2012; 43: 676-85. [CrossRef]

24. Muraki S, Yamamoto S, Ishibashi H, Nakamura K. Factors associated with mortality following hip fracture in Japan. J Bone Miner Metab 2006; 24: 100-4. [CrossRef]

25. Chang JD, Kim IS, Lee SS, Yoo JH, Hwang JH. Unstable intertrochanteric versus displaced femoral neck fractures treated with cementless bipolar hemiarthroplasty in elderly patients; a comparison of 80 matched patients. Orthop Traumatol Surg Res 2016; 102: 695-9. [CrossRef]

26. Heinonen M, Karppi P, Huusko T, Kautiainen H, Sulkava R. Post-operative degree of mobilization at two weeks predicts one-year mortality after hip fracture. Aging Clin Exp Res 2004; 16: 476-80. [CrossRef]

27. Doruk H, Mas MR, Yildiz C, Sonmez A, Kırdemir V. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr 2004; 39: 179-85. [CrossRef]

28. Mutlu H, Bilgili F, Mutlu S, Karaman O, Cakal B, Ozkaya U. The effects of preoperative non-invasive cardiac tests on delay to surgery and subsequent mortality in elderly patients with hip fracture. J Back Musculoskelet Rehabil 2016; 29: 49-54. [CrossRef]

29. Atay İM, Aslan A, Atay T, Burç H. Prevalence of delirium, risk factors and cognitive functions in elderly hip fracture patients with general and spinal anesthesia. Turkish Journal of Geriatrics 2012; 15: 273-8.

30. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 2004; CD000521. [CrossRef]