1New York University Hospital for Joint Diseases, New York, NY.
J Bone Joint Surg Am. 2017 Jul 5;99(13):e68. doi: 10.2106/JBJS.16.00697.
The number of hip fractures is rising as life expectancy increases. As such, the number of centenarians sustaining these fractures is also increasing. The purpose of this study was to determine whether patients who are ≥100 years old and sustain a hip fracture fare worse in the hospital than those who are younger.
Using a large database, the New York Statewide Planning and Research Cooperative System (SPARCS), we identified patients who were ≥65 years old and had been treated for a hip fracture over a 12-year period. Data on demographics, comorbidities, and treatment were collected. Three cohorts were established: patients who were 65 to 80 years old, 81 to 99 years old, and ≥100 years old (centenarians). Outcome measures included hospital length of stay, estimated total costs, and in-hospital mortality rates.
A total of 168,087 patients with a hip fracture were identified, and 1,150 (0.7%) of them had sustained the fracture when they were ≥100 years old. Centenarians incurred costs and had lengths of stay that were similar to those of younger patients. Despite the similarities, centenarians were found to have a significantly higher in-hospital mortality rate than the younger populations (7.4% compared with 4.4% for those 81 to 99 years old and 2.6% for those 65 to 80 years old; p < 0.01). Male sex and an increasing number of medical comorbidities were found to predict in-hospital mortality for centenarians sustaining extracapsular hip fractures. No significant predictors of in-hospital mortality were identified for centenarians who sustained femoral neck fractures. An increased time to surgery did not influence the odds of in-hospital mortality.
Centenarians had increased in-hospital mortality, but the remaining short-term outcomes were comparable with those for the younger cohorts with similar fracture patterns. For this extremely elderly population, time to surgery does not appear to affect short-term mortality rates, suggesting a potential benefit to preoperative optimization.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
随着预期寿命的延长，髋部骨折的数量不断增加。因此，发生这些骨折的百岁老人数量也在增加。本研究的目的是确定年龄在 100 岁及以上的髋部骨折患者与年龄较轻的患者相比，在医院的预后是否更差。
我们使用一个大型数据库——纽约州规划与研究合作系统（SPARCS），确定了在 12 年内接受髋部骨折治疗的年龄在 65 岁及以上的患者。收集了人口统计学、合并症和治疗的数据。建立了三个队列：年龄在 65 至 80 岁、81 至 99 岁和年龄在 100 岁及以上（百岁老人）的患者。结果测量包括住院时间、估计总费用和院内死亡率。
共确定了 168087 例髋部骨折患者，其中 1150 例（0.7%）年龄在 100 岁及以上。百岁老人的住院费用和住院时间与年轻患者相似。尽管存在相似之处，但与年龄较小的人群相比，百岁老人的院内死亡率明显更高（7.4%比 81 至 99 岁人群的 4.4%和 65 至 80 岁人群的 2.6%；p<0.01）。男性和合并症数量的增加被认为是预测发生囊外髋部骨折的百岁老人院内死亡率的因素。未发现影响发生股骨颈骨折的百岁老人院内死亡率的显著预测因素。手术时间的延长并不影响院内死亡率的几率。
百岁老人的院内死亡率增加，但与具有相似骨折模式的年轻队列相比，其余短期预后相似。对于这个非常高龄的人群，手术时间似乎不会影响短期死亡率，这表明术前优化可能有潜在的益处。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
