Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
Geriatr Gerontol Int. 2013 Jan;13(1):190-7. doi: 10.1111/j.1447-0594.2012.00885.x. Epub 2012 Jun 11.
To compare clinical characteristics and outcome of nonagenarian hip fracture patients with younger patients aged 65-89 years.
This was a cohort follow-up study of admissions for a hip fracture between 2005-2010 (mean follow up of 3.5 years) in two teaching hospitals in The Netherlands; 230 nonagenarians and 1014 patients aged 65-89 years were included. Clinical characteristics, adverse events, mobility and mortality were compared.
Nonagenarians were more likely to be female and anemic (both P<0.001), and had more trochanteric fractures (P=0.005). The number of American Society of Anesthesiologists III/VI classified patients did not differ between the two groups. During the hospital stay, adverse events were more frequently observed in nonagenarians compared with younger patients (P<0.001). The length of stay was significantly longer in nonagenarians (P<0.001), and the 90-day readmission rate was similar. Absolute mortality was higher in nonagenarians (P<0.001), excess mortality, however, was comparable. Before admission, 40.0% of the nonagenarians lived in their own home, and 40.9% had returned 3 months postfracture. The rate of returning to their own home was lower compared with younger patients (P<0.001). Prefracture mobility was worse in nonagenarians compared with the younger group, but 3 months after discharge, the number of patients that regained prefracture mobility was comparable in both age groups.
Nonagenarian hip fracture patients differ significantly from younger patients aged 65-89 years with respect to clinical characteristics and long-term outcome. However, almost half of the nonagenarians returned to their own home and more than half regained their prefracture level of mobility. Given these findings, prevention strategies for hip fracture and adverse events during hospital stay that focus particularly on frail nonagenarians are highly recommended.
比较 90 岁以上髋部骨折患者与 65-89 岁年轻患者的临床特征和结局。
这是荷兰 2 家教学医院 2005-2010 年收治髋部骨折患者的队列随访研究（平均随访 3.5 年）；共纳入 230 名 90 岁以上患者和 1014 名 65-89 岁患者。比较了两组患者的临床特征、不良事件、活动能力和死亡率。
90 岁以上患者更可能为女性和贫血（均 P<0.001），且转子间骨折更多（P=0.005）。两组患者美国麻醉医师协会（ASA）分级 III/VI 患者数量无差异。住院期间，90 岁以上患者的不良事件更常见（P<0.001）。90 岁以上患者的住院时间显著延长（P<0.001），90 天内再入院率相似。90 岁以上患者的绝对死亡率更高（P<0.001），但超额死亡率相当。骨折前，40.0%的 90 岁以上患者居住在自己家中，40.9%的患者在骨折后 3 个月返回家中。与年轻患者相比，90 岁以上患者返回家中的比例较低（P<0.001）。骨折前，90 岁以上患者的活动能力较年轻患者差，但出院后 3 个月，两组患者恢复骨折前活动能力的人数相当。
90 岁以上髋部骨折患者与 65-89 岁年轻患者在临床特征和长期结局方面存在显著差异。然而，近一半的 90 岁以上患者返回自己家中，超过一半的患者恢复了骨折前的活动能力。鉴于这些发现，强烈建议针对髋部骨折和住院期间不良事件制定专门针对虚弱 90 岁以上患者的预防策略。
