Department of Orthopedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3145-3154. doi: 10.1007/s00402-022-04550-x. Epub 2022 Jul 21.
Surgical management of geriatric hip fractures yields improved functional outcomes with decreased morbidity and mortality. Cohort studies have suggested that the older patients within the geriatric age group have worse outcomes with surgery, However, these studies inherently report inflated risks due to poor handling of confounders and have inadequately age-stratified their geriatric population.
This study aims to investigate the effect of age alone on the 1-year mortality and functional status of geriatric patients after hip fracture surgery.
This is a retrospective single institution cohort study based on the prospectively-maintained registry of hip fracture patients. 2603 patients aged 60 years and above were treated surgically under a geriatric-orthopaedic hip fracture pathway from January 2014 to December 2018. Patients were split into two age groups: ultra-old (≥ 85 years) vs old (< 85 years). Baseline demographics and the ASA (American Society of Anaesthesiologists) status and the Modified Barthel's Index (MBI) were obtained at admission and 1 year after the fracture. Adverse outcomes from the fracture and surgery were recorded during a follow-up period of minimally 2 years. A 2:1 matching process based on the gender, fracture type, ASA status, CCI and MBI categories was conducted.
There were 1009 and 515 patients in the old and ultra-old age groups, respectively. 1-year mortality was similar for both age groups (4.0% ultra-old vs 3.6% old, p = 0.703). 30-day morbidity was similar except for higher rates of postoperative pneumonia in the ultra-old (14.0 vs 6.3%, p < 0.001). MBI scores at 1-year were lower in the ultra-old (severe dependence: 16.4 vs 10.0%; p = 0.001). Ultra-old patients were less likely to be community ambulant at 12 months (21.2 vs 36.0%) with the deterioration in ambulatory status significant after correction for baseline status (p < 0.001).
The 1-year mortality of surgically-managed geriatric hip fracture patients older than 85 years of age is not determined by age alone. Patients aged 85 years and above are at higher risk for pneumonia postoperatively. Ultra-old hip fracture patients with an intertrochanteric fracture are more likely to have poorer function at 1 year after hip fracture surgery.
老年髋部骨折的手术治疗可改善功能结局，降低发病率和死亡率。队列研究表明，老年人群中年龄较大的患者手术治疗效果较差，但这些研究由于对混杂因素处理不当，以及对老年人群未进行充分的年龄分层，因此报告的风险过高。
本研究旨在探讨年龄因素对老年髋部骨折手术后患者 1 年死亡率和功能状态的影响。
这是一项基于前瞻性维护的髋部骨折患者登记处的回顾性单中心队列研究。2014 年 1 月至 2018 年 12 月，2603 名年龄在 60 岁及以上的患者通过老年骨科髋部骨折途径接受手术治疗。患者分为两组：超高龄组（≥85 岁）和高龄组（＜85 岁）。在骨折和手术后的随访期至少为 2 年的情况下，记录骨折和手术的不良预后。根据性别、骨折类型、ASA 状态、CCI 和 MBI 类别，进行了 2:1 的匹配过程。
高龄组和超高龄组分别有 1009 例和 515 例患者。两组 1 年死亡率相似（超高龄组 4.0%，高龄组 3.6%，p=0.703）。除超高龄组术后肺炎发生率较高（14.0%比 6.3%，p＜0.001）外，30 天发病率相似。超高龄组患者在 1 年时的 MBI 评分较低（严重依赖：16.4%比 10.0%；p=0.001）。12 个月时，超高龄组患者社区活动能力较差的比例较低（21.2%比 36.0%），但在纠正基线状态后，活动状态恶化有统计学意义（p＜0.001）。
85 岁以上接受手术治疗的老年髋部骨折患者的 1 年死亡率并非仅由年龄决定。85 岁及以上患者术后发生肺炎的风险较高。股骨转子间骨折超高龄髋部骨折患者术后 1 年功能更差。
