One-Year Mortality Rates of Patients with Surgically Treated Hip Fractures over the Age of 65

Yıl 2019, Cilt: 9 Sayı: 2, 57 - 60, 31.05.2019

Yalçın Turhan , Mehmet Arıcan

https://doi.org/10.33631/duzcesbed.528982

Cited By: 1

Öz

Aim:
Fractures of the hip are frequently seen in the elderly patients and closely
related to severe morbidity, disability, and even increased mortality. The aim
of this study was to evaluate the first year mortality rate and the factors
affecting this in the patients with surgically treated hip fractures.

Material and Methods: In this retrospective study, 164 patients aged over
65 years who had undergone surgery in our clinics for isolated
intertrochanteric femur or femoral neck fractures between October 2014 and
February 2018 were evaluated. The necessary information such as age, gender,
type of fracture and applied implant, the times between hospitalization/surgery
and surgery/discharge were obtained from the archive records. In addition, the
patients were contacted by phone and the death times (if they died) were
learned. Patients were divided into two groups as who died in the first year
after surgery and survived; and then factors affecting the mortality were
analyzed comparatively.

Results: This study included 138 patients who meet eligibility criteria. One
year mortality rate after surgery was 21.73%. The mean age of the death group
(85.97±7.49) was statistically significantly higher than the survival group
(79.02±8.92) (p=0.0001).
The ratio of the female patients
in the death group was found to be statistically significantly higher than the survival group (p=0.037).
There were not any statistically significant difference between the death and
survival groups in terms of fracture and applied implant types (p=0.881 and
p=0.101). The mean times between hospitalization/surgery and surgery/discharge
were statistically significantly higher in the death group (p=0.034 and
p=0.0001).

Conclusion: In this study, the mortality rate in the
first year after surgery was found to be 21.73% and the most important factors
affecting this rate were determined as advanced age and increased times between
hospitalization/surgery and surgery/discharge.

Anahtar Kelimeler

Hip fractures, death rate, hip replacement arthroplasty, intramedullary nailing

Kalça Kırığı Nedeniyle Cerrahi Tedavi Uygulanan 65 Yaş Üstü Hastaların Bir Yıllık Mortalite Oranları

Öz

Amaç:
Yaşlı hastalarda sık gözlenen kalça kırıkları ciddi morbidite, maluliyet ve
hatta artmış mortalite ile yakından ilişkilidir. Bu çalışmada kalça kırığı
sebebiyle cerrahi tedavi uygulanan hastaların, cerrahiden sonraki ilk bir yılda
gözlenen mortalite oranı ve buna etki eden faktörlerin incelenmesi
amaçlanmıştır.

Gereç
ve Yöntemler: Kliniğimizde Ekim 2014-Şubat 2018
tarihleri arasında izole intertrokanterik femur ya da femur boyun kırıkları
nedeniyle cerrahi tedavi uygulanan 65 yaş üzeri 164 hasta geriye dönük olarak
incelendi. Arşiv kayıtları üzerinden hastalara ait yaş, cinsiyet, kırık tipi,
yatış-cerrahi arası zaman, cerrahi-taburculuk arası zaman ve kırık için
uygulanan implant tipi gibi gerekli bilgilere ulaşıldı. Ayrıca hastalara
telefon ile ulaşılarak vefat tarihleri (vefat etti iseler) öğrenildi. Hastalar;
cerrahi sonrasındaki ilk bir yıl içinde vefat edenler ve yaşayanlar olarak iki
gruba ayrıldı ve mortaliteye etki eden faktörler açısından karşılaştırmalı
analizler yapıldı.

Bulgular:
Çalışmaya kriterlere uygun 138 hasta dahil edildi. Cerrahi sonrası ilk 1
yıldaki ölüm oranı %21,73 olarak bulundu. Vefat edenler grubunun yaş ortalaması
(85,97±7,49) yaşayanlar grubundan (79,02±8,92) istatistiksel olarak anlamlı
derecede yüksek bulundu (p=0,0001). Vefat edenler grubundaki kadın hasta oranı
yaşayanlar grubundan istatistiksel olarak anlamlı derecede yüksek bulundu
(p=0,037). Vefat edenler ve yaşayanlar grupları arasında kırık tipi ve
uygulanan implant türü açısından anlamlı derecede farklılık gözlenmedi (p=0,881
ve p=0,101). Vefat edenler grubunun yatış-cerrahi arası süre ile
cerrahi-taburculuk arası süre ortalamaları yaşayanlar grubundan istatistiksel
olarak anlamlı derecede yüksek bulundu (p=0,034 ve p=0,0001).

Sonuç:
Bu çalışmada cerrahi sonrası ilk bir yıldaki mortalite oranı %21,73 olarak
bulundu ve mortaliteye etki eden en önemli faktörlerin ileri yaş ile artmış
yatış-cerrahi ve cerrahi-taburculuk arası süre olduğu tespit edildi.

Anahtar Kelimeler

Kalça kırıkları, ölüm oranı, kalça replasman artroplasti, intrameduler çivileme

Kaynakça

• 1. Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: A randomized, controlled trial. J Am Geriatr Soc. 2005; 53(9): 1476-82.
• 2. Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Johnsen V, Hochberg M, et al. Incidence rates of fragility hip fracture in middle-aged and elderly men and women in southern Norway. Age and Ageing. 2012; 41(1): 86-92.
• 3. Griffiths EJ, Cash DJ, Kalra S, Hopgood PJ. Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures. Injury. 2013; 44(12): 1949-52.
• 4. Pande I, Scott DL, O’Neill TW, Pritchard C, Woolf AD, Davis MJ. Quality of life, morbidity, and mortality after low trauma hip fracture in men. Ann Rheum Dis. 2006; 65(1): 87-92.
• 5. Lustosa LP, Bastos EO. Fraturas proximais do fêmur em idosos: Qual o melhor tratamento? Acta Ortop Bras. 2009; 17(5): 309-12.
• 6. Daugaard CL, Jorgensen HL, Riis T, Lauritzen JB, Duus BR, vander Mark S. Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays? A retrospective study of 38,020 patients. Acta Orthop. 2012; 83(6): 609-13.
• 7. Guerra MTE, Viana RD, Feil L, Feron ET, Maboni J, Vargas ASG. One-year mortality of elderly patients with hip fracture surgically treated at a hospital in Southern Brazil. Revista Brasileira de Ortopedia. 2017; 52(1): 17-23.
• 8. Ribeiro TA, Premaor MO, Larangeira JA, Brito LG, Luft M, Guterres LW, et al. Predictors of hip fracture mortality at a general hospital in South Brazil: An unacceptable surgical delay. Clinics (Sao Paulo). 2014; 69(4): 253-8.
• 9. Ricci G, Longaray MP, Gonçalves RZ, Ungaretti Neto AS, Manente M, Barbosa LBH. Avaliação da taxa de mortalidadeem um ano após fratura de quadril e fatores relacionados àdiminuição da sobrevida no idoso. Rev Bras Ortop. 2012; 47(3): 304-9.
• 10. Pereira SR, Puts MT, Portela MC, Sayeg MA. The impact of prefracture and hip fracture characteristics on mortality in older persons in Brazil. Clin Orthop Relat Res. 2010; 468(7): 1869-83.
• 11. Meessen JM, Pisani S, Gambino ML, Bonarrigo D, van SchoorNM, Fozzato S, et al. Assessment of mortality risk in elderly patients after proximal femoral fracture. Orthopedics. 2014; 37(2): 194-200.
• 12. Belmont PJ Jr, Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ. Risk factors for complications and in-hospital mortality following hip fractures: A study using the National Trauma Data Bank. Arch Orthop Trauma Surg. 2014; 134(5): 597-604.
• 13. Holt G, Smith R, Duncan K, Finlayson DF, Gregori A. Early mortality after surgical fixation of hip fractures in the elderly: An analysis of data from the Scottish hip fracture audit. The Journal of Bone and Joint Surgery (British vol). 2008; 90(10): 1357-63.
• 14. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD. Hip fracture in the elderly: Predictors of one year mortality. J Orthop Trauma. 1997; 11(3): 162-5.
• 15. Endo Y, Aharanoff GB, Zuckerman JD, Egol KA, Koval KJ. Gender differences in patients with hip fracture: A greater risk of morbidity and mortality in men. J Orthop Trauma. 2005; 19(1): 29-35.
• 16. Frost SA, Nguyen ND, Center JR, Eisman JA, Nguyen TV. Excess mortality attributable to hip-fracture: A relative survival analysis. Bone. 2013; 56(1): 23-9.
• 17. Pugely AJ, Martin CT, Gao Y, Klocke NF, Callaghan JJ, Marsh JL. A risk calculator for short-term morbidity and mortality after hip fracture surgery. J Orthop Trauma. 2014; 28(2): 63-9.
• 18. Dubljanin-Raspopović E, Marković-Denić L, Marinković J, Nedeljković U, Bumbaširević M. Does early functional outcome predict 1-year mortality in elderly patients with hip fracture? Clin Orthop Relat Res. 2013; 471(8): 2703-10.
• 19. Vaseenon T, Luevitoonvechkij S, Wongtriratanachai P, Rojanasthien S. Long-term mortality after osteoporotic hip fracture in Chiang Mai, Thailand. J Clin Densitom. 2010; 13(1): 63-7.
• 20. Neuhaus V, King J, Hageman MG, Ring DC. Charlson comorbidity indices and in hospital deaths in patients with hip fractures. Clin Orthop Relat Res. 2013; 471(5): 1712-9.
• 21. Khan SK, Rushton SP, Dosani A, Gray AC, Deehan DJ. Factors influencing length of stay and mortality after first and second hip fractures: An event modeling analysis. J Orthop Trauma. 2013; 27(2): 82-6.
• 22. Baker DM. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am. 1997; 79(3): 470.
• 23. Öztürk I, Toker S, Ertürer E, Aksoy B, Seçkin F. Kalça kırığı nedeniyle ameliyat edilen 65 yaş üstü hastalarda mortaliteye etki eden risk faktörlerinin değerlendirilmesi. Acta Orthop Traumatol Turc. 2008; 42(1): 16-21.
• 24. Astur DC, Arliani GG, Balbachevsky D, Fernandes HJ, Reis FB. Fraturas da extremidade proximal do fêmur tratadas no Hospital São Paulo/Unifesp - Estudo epidemiológico. RBM Espec Ortop. 2011; 68(4): 11-5.