Surgical Intervention Provides Better Outcomes for Hip Fracture in Extremely Old Patients: A Retrospective Observational Study

Abstract

Abstract BACKGROUND: Hip fracture is a common disease in the elderly. Among these patients, surgical intervention for hip fracture should be carefully considered because of old age and multiple comorbidities. There are still insufficient comparisons between patients treated with surgery and those treated non-surgically.OBJECTIVES: We studied hip fracture patients >90 years of age to compare the different outcomes between surgical and non-surgical treatments.DESIGN: Retrospective observational study.METHODS: Patients aged > 90 years who visited the emergency department with hip fractures between March 2010 and October 2019 were identified. Overall survival was estimated using multivariate Cox proportional hazards models. We compared the mortality rates at 30 days, 1 year, and 2 years between surgical and non-surgical patients. We also recorded the length of hospital stay, intra-admission, and 30-day complication and readmission rates.RESULTS: A total of 152 patients who underwent surgery (OP group) and 32 who received conservative treatment (non-OP group) were included. The estimated median survival time was 58.47 months in the OP group, which was significantly higher than the 24.28 months in the non-OP group. After adjusting for covariates, including age, sex, Charlson Comorbidity Index (CCI), injury severity score, and fracture type, the risk of death was reduced by surgery (hazard ratio [HR]=0.427; 95% confidence interval [CI]: 0.207-0.882; p=0.021). CCI was also an independent risk factor for poor survival rate (HR=1.3; 95% CI: 1.115-1.515; p=0.001). After adjusting for several factors, surgery within 48 h improved overall survival (HR: 2.518; 95% CI: 1.299-4.879; p=0.006).CONCLUSION: Our study suggests that surgery is likely to provide better outcomes for extremely old patients with hip fractures. Operative management should be recommended because it decreases the short-term complication rate and provides better long-term survival than non-operative management. Operation performed within 48 h of admission has better overall survival than that performed after >48 hours.