Comparison of Survival Rates in Elderly Patients with Hip Fractures Undergoing Proximal Femoral Nail Antirotation (PFNA) or Hip Arthroplasty Within and Beyond 72 Hours at Bang Pa-in Hospital
Keywords:
Hip Arthroplasty, Proximal Femoral Nail Antirotation (PFNA), Survival RateAbstract
Objective: To compare survival rates and identify factors associated with survival among elderly patients with hip fractures who underwent either proximal femoral nail antirotation (PFNA) fixation or hip arthroplasty, stratified by surgery performed within and beyond 72 hours after fracture.
Methods: This retrospective cohort study included 140 patients aged ≥60 years who underwent PFNA fixation or hip arthroplasty for hip fractures at Bang Pa-in Hospital between 2018 and 2022. Patients were categorized into two groups based on surgical timing: ≤72 hours and >72 hours.
Results: Patients in the >72-hour group had significantly higher mean age and Charlson Comorbidity Index scores than those in the ≤72-hour group (p < 0.01). The delayed surgery group had a significantly higher mortality rate (28.57% vs. 12.86%, p = 0.02) and overall complication rate (28.57% vs. 8.57%, p = 0.002). Additionally, patients operated within 72 hours had significantly higher Activities of Daily Living (ADL) scores at weeks 6 and 12 postoperatively (p < 0.05). However, multiple Cox regression analysis revealed no statistically significant association between surgical timing and survival (adjusted HR = 0.54, 95% CI: 0.19–1.52, p = 0.24).
Conclusion: Although the multiple Cox regression analysis did not demonstrate a statistically significant association between surgery within 72 hours and mortality, early surgery was associated with a lower incidence of postoperative complications and better functional recovery of the hip compared with delayed surgery. Therefore, performing PFNA fixation or hip arthroplasty within 72 hours should be considered when clinically feasible and in the absence of contraindications to optimize patient outcomes.
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