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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Mortality, readmission, and reoperation after hip fracture in nonagenarians

Authors: Jeff Chien-Fu Lin, Wen-Miin Liang

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Osteoporotic hip fractures are associated with high mortality and morbidity in people of advanced age; however, few studies have investigated the complication rates in nonagenarians. In this study, we applied a competing risk analysis to estimate the mortality, readmission, and reoperation rates after surgery for hip fracture among nonagenarians.

Methods

A total of 11,184 nonagenarians (aged ≥ 90) who received surgery for hip fracture during the period 1 January 1997 and 31 December 2010 were selected from Taiwan’s National Health Insurance (NHI) database. Nonagenarians were followed up until the end of 2012, death, or the date they left the NHI program. Cumulative mortality was estimated using the Kaplan-Meier analysis and risk factors for mortality were investigated using a Cox proportional hazards model. Competing risk analysis was used to estimate cumulative incidence rates and to assess the risk factors for reoperation and readmission.

Results

The mortality rates were 29.5% at 1 year, 45.0% at 2 years and 78.1% at 5 years. The cumulative incidence rates of reoperation were 7.3% at 1 year, 9.2% at 2 years and 11.6% at 5 years whereas those of readmission were 18.9% at 1 month and 24.1% at 3 months. Significant risk factors for death included age, male gender, trochanteric fracture, and higher Charlson comorbidity index (CCI) whereas those for reoperation were age, cervical fracture and higher CCI. Furthermore, age, male gender, and higher CCI were risk factors for readmission.

Conclusions

The overall 2-years mortality rate among nonagenarians in Taiwan was around 45%, the 2-years reoperation rate was around 9% and the 90-days medical complication rate was around 24%. High complication rates are associated with increased risk for death. Postoperative care to prevent medical complications is likely the most effective strategy to reduce mortality rates among nonagenarians with hip fracture.
Literature
1.
Tsuboi M, Hasegawa Y, Suzuki S, Wingstrand H, Thorngren KG. Mortality and mobility after hip fracture in Japan: a 10-years follow-up. J Bone Joint Surg Br. 2007;89:461–6.CrossRefPubMed
2.
Holt G, Smith R, Duncan K, Finlayson DF, Gregori A. Early mortality after surgical fixation of hip fractures in the elderly: an analysis of data from the scottish hip fracture audit. J Bone Joint Surg Br. 2008;90:1357–63.CrossRefPubMed
3.
Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury. 2008;39:1157–63.CrossRefPubMed
4.
Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–50.CrossRefPubMed
5.
6.
Haentjens P, Magaziner J, Colon-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152:380–90.CrossRefPubMedPubMedCentral
7.
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.CrossRefPubMed
8.
Wang CB, Lin CF, Liang WM, et al. Excess mortality after hip fracture among the elderly in Taiwan: a nationwide population-based cohort study. Bone. 2013;56:147–53.CrossRefPubMed
9.
MacCollum 3rd MS, Karpman RR. Approaches to senior care #8. Hip fractures in nonagenarians. Orthop Rev. 1989;18:471–7.PubMed
10.
11.
Jennings AG, de Boer P. Should we operate on nonagenarians with hip fractures? Injury. 1999;30:169–72.CrossRefPubMed
12.
Alarcon T, Gonzalez-Montalvo JI, Barcena A, Saez P. Further experience of nonagenarians with hip fractures. Injury. 2001;32:555–8.CrossRefPubMed
13.
Shah MR, Aharonoff GB, Wolinsky P, Zuckerman JD, Koval KJ. Outcome after hip fracture in individuals 90 years of age and older. J Orthop Trauma. 2001;15:34–9.CrossRefPubMed
14.
Ishida Y, Kawai S, Taguchi T. Factors affecting ambulatory status and survival of patients 90 years and older with hip fractures. Clin Orthop Relat Res. 2005;436:208–15.CrossRef
15.
Ooi LH, Wong TH, Toh CL, Wong HP. Hip fractures in nonagenarians—a study on operative and non-operative management. Injury. 2005;36:142–7.CrossRefPubMed
16.
Holt G, Macdonald D, Fraser M, Reece AT. Outcome after surgery for fracture of the hip in patients aged over 95 years. J Bone Joint Surg Br. 2006;88:1060–4.CrossRefPubMed
17.
van de Kerkhove MP, Antheunis PS, Luitse JS, Goslings JC. Hip fractures in nonagenarians: perioperative mortality and survival. Injury. 2008;39:244–8.CrossRefPubMed
18.
Holt G, Smith R, Duncan K, Hutchison JD, Gregori A. Outcome after surgery for the treatment of hip fracture in the extremely elderly. J Bone Joint Surg Am. 2008;90:1899–905.CrossRefPubMed
19.
Bergeron E, Moore L, Fournier K, Gravel C, Lavoie A. Patients with isolated hip fracture must be considered for surgery irrespectively of their age, comorbidity status and provenance: a statement applicable even to nonagerians. Arch Orthop Trauma Surg. 2009;129:1549–55.CrossRefPubMed
20.
Takamine B, Morii T, Watanabe H, Tajima T, Satomi K. Short-term postoperative mortality events in patients over 80 years of age with hip fracture: analysis at a single institution with limited medical resources. J Orthop Sci. 2010;15:437–42.CrossRefPubMed
21.
Clement ND, Aitken SA, Duckworth AD, McQueen MM, Court-Brown CM. The outcome of fractures in very elderly patients. J Bone Joint Surg Br. 2011;93:806–10.CrossRefPubMed
22.
23.
Kadowaki M, Kono M, Nishiguchi K, Kakimaru H, Uchio Y. Mortality in patients with hip fracture aged over 90 years: a report from a progressively aging island. Arch Gerontol Geriatr. 2012;54:e113–7.CrossRefPubMed
24.
de Leur K, Vroemen JP, Vos DI, Elmans L, van der Laan L. Outcome after osteosynthesis of hip fractures in nonagenarians. Clin Interv Aging. 2014;9:41–9.PubMed
25.
Tay YW, Hong CC, Murphy D. Functional outcome and mortality in nonagenarians following hip fracture surgery. Arch Orthop Trauma Surg. 2014;134:765–72.CrossRefPubMed
26.
27.
Boockvar KS, Halm EA, Litke A, et al. Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes. J Am Geriatr Soc. 2003;51:399–403.CrossRefPubMed
28.
French DD, Bass E, Bradham DD, Campbell RR, Rubenstein LZ. Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc. 2008;56:705–10.CrossRefPubMed
29.
Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am. 2008;90:34–42.CrossRefPubMed
30.
Giusti A, Barone A, Razzano M, Pizzonia M, Oliveri M, Pioli G. Predictors of hospital readmission in a cohort of 236 elderly discharged after surgical repair of hip fracture: 1-year follow-up. Aging Clin Exp Res. 2008;20:253–9.CrossRefPubMed
31.
32.
Khan MA, Hossain FS, Dashti Z, Muthukumar N. Causes and predictors of early re-admission after surgery for a fracture of the hip. J Bone Joint Surg Br. 2012;94:690–7.CrossRefPubMed
33.
34.
Buecking B, Eschbach D, Koutras C, et al. Re-admission to level 2 unit after hip-fracture surgery - risk factors, reasons and outcome. Injury. 2013;44:1919–25.CrossRefPubMed
35.
Teixeira A, Trinquart L, Raphael M, Bastianic T, Chatellier G, Holstein J. Outcomes in older patients after surgical treatment for hip fracture: a new approach to characterise the link between readmissions and the surgical stay. Age Ageing. 2009;38:584–9.CrossRefPubMed
36.
Berry SD, Ngo L, Samelson EJ, Kiel DP. Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc. 2010;58:783–7.CrossRefPubMedPubMedCentral
37.
Pintilie M. Competing risks : a practical perspective. Chichester, England. Hoboken, NJ: John Wiley & Sons; 2006.CrossRef
38.
Beyersmann J. Competing risks and multistate models with R. New York: Springer; 2011.
39.
40.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed
41.
Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int. 2004;15:897–902.CrossRefPubMed
42.
Magaziner J, Lydick E, Hawkes W, et al. Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health. 1997;87:1630–6.CrossRefPubMedPubMedCentral
43.
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone. 2003;32:468–73.CrossRefPubMed
44.
Forsen L, Sogaard AJ, Meyer HE, Edna T, Kopjar B. Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int. 1999;10:73–8.CrossRefPubMed
45.
Vestergaard P, Rejnmark L, Mosekilde L. Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int. 2007;18:1583–93.CrossRefPubMed
46.
Gronskag AB, Romundstad P, Forsmo S, Langhammer A, Schei B. Excess mortality after hip fracture among elderly women in Norway. The HUNT study. Osteoporos Int. 2012;23:1807–11.CrossRefPubMed
47.
Lu-Yao GL, Baron JA, Barrett JA, Fisher ES. Treatment and survival among elderly Americans with hip fractures: a population-based study. Am J Public Health. 1994;84:1287–91.CrossRefPubMedPubMedCentral
48.
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.CrossRefPubMed
49.
Haentjens P, Autier P, Barette M, et al. Survival and functional outcome according to hip fracture type: a 1-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture. Bone. 2007;41:958–64.CrossRefPubMed
50.
Lin WP, Wen CJ, Jiang CC, Hou SM, Chen CY, Lin J. Risk factors for hip fracture sites and mortality in older adults. J Trauma. 2011;71:191–7.CrossRefPubMed
51.
Kesmezacar H, Ayhan E, Unlu MC, Seker A, Karaca S. Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma. 2010;68:153–8.CrossRefPubMed
52.
Castronuovo E, Pezzotti P, Franzo A, Di Lallo D, Guasticchi G. Early and late mortality in elderly patients after hip fracture: a cohort study using administrative health databases in the Lazio region, Italy. BMC Geriatr. 2011;11:37.CrossRefPubMedPubMedCentral
53.
Gjertsen JE, Vinje T, Engesaeter LB, et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am. 2010;92:619–28.CrossRefPubMed
54.
Radley DC, Gottlieb DJ, Fisher ES, Tosteson AN. Comorbidity risk-adjustment strategies are comparable among persons with hip fracture. J Clin Epidemiol. 2008;61:580–7.CrossRefPubMedPubMedCentral
55.
Kirkland LL, Kashiwagi DT, Burton MC, Cha S, Varkey P. The Charlson comorbidity index score as a predictor of 30-days mortality after hip fracture surgery. Am J Med Qual. 2011;26:461–7.CrossRefPubMed
Metadata
Title
Mortality, readmission, and reoperation after hip fracture in nonagenarians
Authors
Jeff Chien-Fu Lin
Wen-Miin Liang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1493-5

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