Survival Time after Fragility Hip Fractures in Very-Old Age Patients Comparing Operative Versus Nonoperative Treatment

Abstract

Background: Fragility hip fractures in the elderly are associated with high mortality. Although operative treatment can reduce complications and improve survival, decision-making in very-old age patients (≥80 years), who often present with multiple comorbidities, remains challenging.
Objective: To describe characteristics of very-old age patients with hip fractures, compare survival between operative and non-operative treatment, and identify factors associated with survival.
Methods: A retrospective cohort study was conducted among patients aged ≥80 years admitted with hip fractures over a 3-year period, excluding high-energy trauma and prior hip fractures.
Results: A total of 219 patients aged 80–99 years were included. Of these, 175 patients (79.9%) received operative treatment. Median survival and 1-year survival rates were 1,722 days and 81.4% for the operative group, compared to 158 days and 43.2% in the non-operative group, respectively (p < 0.001). Survival differed significantly between groups (p < 0.001). Survival time for operative treatment was 3.07-fold longer than that of non-operative treatment significantly (p < 0.001).
Conclusion: Operative treatment substantially improves survival in very-old age patients with hip fractures. Despite the high-risk nature of this population, operative treatment should be considered when appropriate. Systematic preoperative health assessment is essential to identify suitable candidates.