Mortality and Prognosis Factors of Elderly Patients with Pertrochanteric Fracture: Re-evaluation in Maharat Nakhon Ratchasima Hospital
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Abstract
Purpose: To study the one-year mortality rate and risk factors that affected one-year mortality of elderly pertrochanteric fracture patients.
Methods: A retrospective cohort study of 682 pertrochanteric fracture patients, aged more than 60 years, treated at Maharat Nakhon Ratchasima hospital between January 2008 and December 2011 was carried out in which one-year mortality was assessed. The risk factors including treatment methods, gender, age, co-morbidities, American Society of Anesthesiologists classification, surgical methods, waiting time before surgery, and in-hospital complications were analyzed.
Results: The overall one-year mortality rate was 29.33%. Factors that significantly affected one-year mortality were nonoperative treatment, age, more than one co-morbidity, chronic kidney disease, and in-hospital complications. The surgical group had a lower one-year mortality rate than the nonoperative group (odds ratio 0.21; 95% CI 0.15-0.3). Surgical methods and waiting time before surgery did not significantly affect mortality rates. In-hospital complications especially pneumonia and urinary tract infections significantly increased the one-year mortality rate (odds ratio 7.34; 95 % CI 3.18-13.95 and 1.23; 95 % CI 2.19-9.15, respectively)
Conclusion: Elderly pertrochanteric fracture risk factors have to be considered to decrease one-year mortality. Operative treatment is the treatment of choice for elderly pertrochanteric fractures.
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References
2. Gong MQ, Mao YJ, Wei J, Wang MY, Bai J, Fan QL, et al. Outcome of hip fractures after traction treatment in elderly. Zhonghua Yi Xue Za Zhi 2005; 85: 3263-3265.
3. Kazakos K, Lyras DN, Verettas D, Galanis V, Psillakis I, Xarchas K. External fixation of intertrochanteric fractures in elderly high risk patients. Acta Orthop Belg 2007; 73: 44-48.
4. Hornby R, Evans JG, Vardon V. Operative or conservative treatment for trochanteric fracture of the femur. A randomized epidemiological trial in elderly patients. J Bone Joint Surg Br 1989; 71: 619-623.
5. Handoll HH, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev 2008: CD000337.
6. Dzupa V, Bartonicek J, Skala-Rosenbaum J, Prikazsky V. Mortality in patients with proximal femoral fractures during the first year after the injury. Acta Chir Orthop Traumatol Cech 2002; 69: 39-44.
7. Chariyalertsak S, Suriwongpisal P, Thakkinstain A. Mortality after hip fractures in Thailand. Int Orthop 2001; 25: 294-297.
8. Rojanasthien S, Luevitoonvechkij S. Epidemiology of hip fracture in Chiang Mai. J Med Assoc Thai 2005; 88: 105-109.
9. Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Mortality risk after hip fracture. J Orthop Trauma 2003; 17: 53-56.
10. Hommel A, Ulander K, Bjorkelund KB, Norrman PO, Wingstrand H, Thorngren KG. Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury 2008; 39: 1164-1174.
11. Ooi LH, Wong TH, Toh CL, Wong HP. Hip fractures in nonagenarians: A study on operative and nonoperative management. Injury 2005; 36: 142-147.
12. Bong SC, Lau HK, Leong JC, Fang D, Lau MT. The treatment of unstable intertrochanteric fractures of the hip: A prospective trial of 150 cases. Injury 1981; 13: 139-146.
13. Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop 2003; 27: 11-17.
14. Ishida Y, Kawai S, Taguchi T. Factors Affecting Ambulatory Status and Survival of Patients 90 Years and Older with Hip Fractures. Clin Orthop Relat Res 2005;436: 208-215.
15. Kitamura S, Hasegawa Y, Suzuki S, Sasaki R, Iwata H, Wingstrand H, et al. Functional outcome after hip fracture in Japan. Clin Orthop Relat Res 1998;348: 29-36.
16. Ingemarsson AH, Frändin K, Mellström D, Möller M. Walking ability and activity level after hip fracture in the elderly: A follow up. J Rehabil Med 2003; 35: 76-83.
17. Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Mortality risk after hip fracture. J Orthop Trauma 2003; 17: 53-56.
18. Lewsirirat S, MD, Thanomsingh P. Mortality and ambulatory status of intertrochanteric fracture treated at Maharat Nakhon Ratchasima Hospital, Thailand. Thai Journal of Orthopaedic Surgery 2010; 34: 25-32.
19. Kesmezacar H, Ayhan E, Unlu MC, Seker A, Karaca S. Predictors of Mortality in Elderly Patients With an Intertrochanteric or a Femoral Neck Fracture. J Trauma 2010; 68: 153-158.
20. Valizadeh M, Mazloomzadeh S, Golmo-hammadi S, Larijani B. Mortality after low trauma hip fracture: a prospective cohort study. BMC Musculoskelet Disord 2012; 13: 143.
21. Kumar R, Singh R.N., Singh B.N. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma 2012; 3: 28-36.
22. Hershkovitz A, Polatov I, Beloosesky Y, Brill S. Factors affecting mortality of frail hip-fractured elderly patients. Arch Gerontol Geriatr 2010; 51: 113-116.
23. Jamal Sepah Y, Umer M, Khan A, Ullah Khan Niazi A. Functional outcome, mortality and in-hospital complications of operative treatment in elderly patients with hip fractures in the developing world. Int Orthop 2010;34:431-435.
24. Haentjens P, Autier P, Barette M, Venken K, Vanderschueren D, Boonen S. Survival and functional outcome according to hip fracture type: A one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture. Bone 2007; 41: 958-964.
25. Casaletto JA, Gatt R. Post-operative mortality related to waiting time for hip fracture surgery. Injury 2004; 35: 114-120.
26. Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: A systematic review and meta-analysis. Injury 2012; 43: 676-685.
27. Vaseenon T, Luevitoonvechkij S, Wongtriratanachai P, Rojanasthien S. Long-term mortality after osteoporotic hip fracture in Chiang Mai, Thailand. J Clin Densitom 2010; 13: 63-67.
28. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int 1997; 7: 407-413.