Comparative Analysis of the Effects of Hemiarthroplasty and Proximal Femoral Nail on Mortality in Hip Fractures

Abstract

This retrospective study aimed to compare the effects of hemiarthroplasty and proximal femoral nail on one-year mortality in patients over 65 years of age with femoral intertrochanteric fractures. A total of 307 patients treated for femoral intertrochanteric fracture between January 1, 2019, and December 31, 2021, were evaluated and divided into two groups: hemiarthroplasty (Group 1) and proximal femoral nail (Group 2). Data collected included demographic information, pre- and postoperative hemoglobin and albumin levels, neutrophil-to-lymphocyte ratios, presence of osteoporosis, duration of surgery, length of hospital stay, postoperative intensive care unit requirement, presence of additional trauma, American Society of Anesthesiologists scores, cardiac ejection fraction values, and comorbidities assessed using the Modified Charlson Comorbidity Index. Receiver operating characteristic analysis was used to determine cut-off values for factors significantly affecting mortality. The mean age of the patients was 81.38 ± 8.014 years, with a mean follow-up of 14.48 ± 9.69 months (range = 1–36). The overall one-year mortality rate was 39.1% (n = 120): 41.9% in Group 1 and 32.6% in Group 2. Univariate regression analysis showed that age, sex, American Society of Anesthesiologists scores, ejection fraction, pre- and postoperative albumin levels, Modified Charlson Comorbidity Index, and intensive care unit stay duration significantly affected mortality. Multiple logistic regression identified male sex as a risk factor in Group 1 and intensive care unit admission in Group 2. This study demonstrates that, irrespective of the implant type, patients' existing chronic illnesses and metabolic conditions must be carefully assessed.

Keywords

• Hemiarthroplasty
• hip fracture
• mortality
• proximal femoral nail

Kalça Kırıklarında Hemiartroplasti ve Proksimal Femur Çivisinin Mortalite Üzerindeki Etkilerinin Karşılaştırmalı Analizi

Abstract

Bu retrospektif çalışma, 65 yaşın üzerindeki femur intertrokanterik kırığı olan hastalarda hemiartroplasti ve proksimal femur çivisi tedavilerinin bir yıllık mortalite üzerindeki etkilerini karşılaştırmayı amaçlamıştır. 1 Ocak 2019 ile 31 Aralık 2021 tarihleri arasında femur intertrokanterik kırığı nedeniyle tedavi edilen toplam 307 hasta değerlendirilmiş ve hemiartroplasti (grup 1) ile proksimal femur çivisi (grup 2) uygulanan iki gruba ayrılmıştır. Toplanan veriler; demografik bilgiler, ameliyat öncesi ve sonrası hemoglobin ve albümin düzeyleri, nötrofil-lenfosit oranları, osteoporoz varlığı, ameliyat süresi, hastanede kalış süresi, ameliyat sonrası yoğun bakım ünitesi gereksinimi, ek travma varlığı, Amerikan Anesteziyologlar Derneği skorları, kardiyak ejeksiyon fraksiyonu değerleri ve Modifiye Charlson Komorbidite İndeksi ile değerlendirilen komorbiditeleri içermiştir. Mortaliteyi anlamlı ölçüde etkileyen faktörlerin kesme değerleri, alıcı işletim karakteristiği (ROC) analizi ile belirlenmiştir. Hastaların yaş ortalaması 81.38 ± 8.014 yıl olup, ortalama takip süresi 14.48 ± 9.69 ay (aralık = 1–36) idi. Genel bir yıllık mortalite oranı %39.1 (n = 120) olup, grup 1'de %41.9 ve grup 2'de %32.6 idi. Tek değişkenli regresyon analizi; yaş, cinsiyet, Amerikan Anesteziyologlar Derneği skorları, ejeksiyon fraksiyonu, ameliyat öncesi ve sonrası albümin düzeyleri, Modifiye Charlson Komorbidite İndeksi ve yoğun bakım ünitesinde kalış süresinin mortaliteyi anlamlı ölçüde etkilediğini göstermiştir. Çok değişkenli lojistik regresyon analizi, grup 1'de erkek cinsiyetini ve grup 2'de yoğun bakıma yatışı risk faktörü olarak belirlemiştir. Bu çalışma, uygulanan implant türünden bağımsız olarak, hastaların mevcut kronik hastalıklarının ve metabolik durumlarının dikkatli biçimde değerlendirilmesi gerektiğini göstermektedir.

Keywords

• Hemiartroplasti
• kalça kırığı
• mortalite
• proksimal femur çivisi

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