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Postoperative delirium and pre-fracture disability predict 6-month mortality among the oldest old hip fracture patients

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Abstract

Background

Age is one of the most robust risk factors for hip fracture. Recent projections indicate that almost half of hip fractures are occurring with an increasing trend among the “oldest old” (i.e., in those aged >85 years).

Aims

To compare clinical characteristics, outcomes, and risk factors for 6-month mortality in two groups of “oldest old” patients (group 1 = 85–89, group 2 > 90 years), after hip fracture surgery.

Methods

Observational prospective cohort study with 6-month follow-up, performed in an Orthogeriatric Unit of an academic hospital between March 2007 and November 2012.

Results

Two hundred seventy-five patients (group 1: N = 171; group 2: N = 104) underwent a comprehensive geriatric assessment, including demographics, clinical, functional, nutritional, and mental status. The 6-month rehospitalization and mortality rates after surgery were assessed through structured telephone interviews with patient’s caregivers. Multivariate logistic regression models were used to evaluate predictors of 6-month mortality, adjusting for relevant covariates. Fifty-eight patients died at follow-up. The in-hospital and 6-month mortality rates were significantly higher for patients of group 2 than for those of group 1. After adjusting for covariates, the multivariate logistic regressions showed that severe disability (OR 2.24, 95 % CI 1.08–4.65) and postoperative delirium (POD) (OR 3.80, 95 % CI 1.72–8.39) were predictors of 6-month mortality.

Conclusions

Patients aged >90 years who underwent hip fracture surgery are more likely to die at 6 months than those aged 85–89 years. Pre-fracture disability and POD are predictors of this excess of mortality.

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Acknowledgments

The authors give their sincere appreciation to Bhavna Abbi, MHS (MD Candidate at St. George’s University School of Medicine, Researcher at the Icahn School of Medicine at Mount Sinai Hospital, New York, USA) for reviewing the English version of this manuscript.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Health Sciences, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy

    Paolo Mazzola, Giuseppe Bellelli, Valentina Broggini, Alessandra Anzuini, Maurizio Corsi & Giorgio Annoni

  2. Geriatric Clinic, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy

    Paolo Mazzola, Giuseppe Bellelli, Valentina Broggini, Alessandra Anzuini, Maurizio Corsi & Giorgio Annoni

  3. Department of Surgery, University of Milano-Bicocca, Monza, Italy

    Daniele Berruti & Giovanni Zatti

  4. Orthopaedic Clinic, San Gerardo Hospital, Monza, Italy

    Daniele Berruti & Giovanni Zatti

  5. Geriatric Rehabilitation Unit, Regional Hospital of Valtellina and Valchiavenna, Sondrio, Italy

    Francesco De Filippi

  6. Geriatric Research Group, GRG, Brescia, Italy

    Giuseppe Bellelli

Authors
  1. Paolo Mazzola
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  8. Giovanni Zatti
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  9. Giorgio Annoni
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Correspondence to Giuseppe Bellelli.

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Mazzola, P., Bellelli, G., Broggini, V. et al. Postoperative delirium and pre-fracture disability predict 6-month mortality among the oldest old hip fracture patients. Aging Clin Exp Res 27, 53–60 (2015). https://doi.org/10.1007/s40520-014-0242-y

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  • DOI: https://doi.org/10.1007/s40520-014-0242-y

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