Scarano Kyle A, Philp Frances H, Westrick Edward R, Altman Gregory T, Altman Daniel T
Albany Medical College, Albany, NY, USA.
Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
Geriatr Orthop Surg Rehabil. 2018 Mar 22;9:2151459318758106. doi: 10.1177/2151459318758106. eCollection 2018.
The United States and the world are currently experiencing a tremendous growth in the elderly population. Moreover, individuals surpassing the ages of 80 and 90 are also continuing to increase. As this unique division of society expands, it is critical that the medical community best understands how to assess, diagnose, and treat this population. The purpose of this study was to analyze morbidity, mortality, and overall outcome of patients aged 90 years and older after orthopedic surgical fracture repair. Such knowledge will guide patients and their families in making decisions when surgery is required among nonagenarians.
The trauma registry of our level I academic medical center was queried to identify potential study participants over the past decade. Two hundred and thirty-three surgical procedures among 227 patients were included and retrospectively assessed. Parameters of specific interest were injury type, mechanism of injury (including high energy vs low energy and height of falls), injury severity score, preoperative comorbidities, postoperative complications, length of hospital stay, discharge destination, and postoperative mortality rate.
Overall, 4.3% of the cohort died in the hospital following surgery. Of the patients who survived, 89.7% were discharged to a professionally supervised setting. The nonagenarian population displayed a considerable follow-up rate, as 82.8% of individuals returned for their first postoperative office visit.
Historically, surgical morbidity and mortality are highly associated with this age group. However, the number of nonagenarians in the United States is increasing, as are these surgical procedures. The epidemiologic and clinical findings of our study support this trend and add further insight into the matter.
This investigation demonstrates that orthopedic surgery is an appropriate treatment in this population with an acceptable complication rate. Furthermore, nonagenarians have the potential to demonstrate a substantial follow-up rate, but postoperative discharge to a professionally supervised setting may be necessary.
美国乃至全球老年人口目前正经历着迅猛增长。此外，80岁及90岁以上的人群数量也在持续增加。随着这一特殊社会群体的不断扩大，医学界充分了解如何评估、诊断和治疗该群体变得至关重要。本研究旨在分析90岁及以上患者骨科手术骨折修复后的发病率、死亡率及总体预后。这些信息将指导患者及其家属在为九旬老人决定是否需要手术时提供参考。
查询我们一级学术医疗中心的创伤登记处，以确定过去十年中的潜在研究参与者。纳入227例患者的233例外科手术，并进行回顾性评估。特别关注的参数包括损伤类型、损伤机制（包括高能量与低能量以及跌倒高度）、损伤严重程度评分、术前合并症、术后并发症、住院时间、出院去向及术后死亡率。
总体而言，该队列中有4.3%的患者术后在医院死亡。存活患者中，89.7%出院后进入专业监管环境。九旬老人群体的随访率相当可观，82.8%的患者术后首次复诊返回。
从历史上看，手术发病率和死亡率与这个年龄组高度相关。然而，美国九旬老人的数量在增加，此类外科手术也在增多。我们研究的流行病学和临床结果支持这一趋势，并为该问题提供了进一步的见解。
本调查表明，骨科手术是该人群的一种合适治疗方法，并发症发生率可接受。此外，九旬老人有相当高的随访率潜力，但术后可能需要出院至专业监管环境。
