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

Öz

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.

Anahtar Kelimeler

• Hemiarthroplasty
• hip fracture
• mortality
• proximal femoral nail

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

Öz

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.

Anahtar Kelimeler

• Hemiartroplasti
• kalça kırığı
• mortalite
• proksimal femur çivisi

Kaynakça

1. Koso RE, Sheets C, Galanos AN, Richardson WJ. Hip fracture in the elderly patients: A sentinel event. Am J Hosp Palliat Care. 2017;35(4):612-619. doi:10.1177/1049909117725057.
2. Tan S, Sathappan S, Jaipaul J, et al. Clinical outcomes and hospital length of stay in 2,756 elderly patients with hip fractures: a comparison of surgical and non-surgical management. Singapore Med J. 2017;58(5):253-257. doi:10.11622/smedj.2016045.
3. Choy WS, Ahn JH, Ko JH, et al. Cementless bipolar hemiarthroplasty for unstable ıntertrochanteric fractures in elderly patients. Clin Orthop Surg. 2010;2(4):221. doi:10.4055/cios.2010.2.4.221.
4. Gadegone WM, Salphale YS. Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. 2006;31(3): 403-408. doi:10.1007/s00264-006-0170-3.
5. Hongku N, Woratanarat P, Nitiwarangkul L, et al. Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a systematic review and network meta-analysis of randomized controlled trials. Ortop Traumatol Surg Res. 2022;108(1):102838. doi:10.1016/j.otsr.2021.102838.
6. Huette P, Abou-Arab O, Djebara AE, et al. Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study. Sci Rep. 2020;10(1). doi:10.1038/s41598-020-66614-5.
7. Bui M, Nijmeijer WS, Hegeman JH, et al. Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery. Osteoporos Int. 2024;35(4):561-574. doi:10.1007/s00198-023-06942-0.
8. Johnson N, Ashford R, Burgula V, et al. Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review. Ann R Coll Surg Engl. 2016;99(2):145-150. doi:10.1308/rcsann.2016.0297.

9. Martinho T, Stoffel K. Treatment of ıntertrochanteric femur fractures with hip arthroplasty in older patients: A narrative review of ındications and outcomes. Medicina. 2021;57(8):763. doi:10.3390/medicina57080763.
10. Johansen A, Tsang C, Boulton C, et al. Understanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database. Anaesthesia. 2017;72(8):961-966. doi:10.1111/anae.13908.
11. Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture-a systematic review. World J Orthop. 2019;10(3):166. doi:10.5312/wjo.v10.i3.166.
12. Ishii S, Ogawa S, Akishita M. The state of health in older adults in japan: trends in disability, chronic medical conditions and mortality. PLoS One. 2015;10(10):e0139639. doi:10.1371/journal.pone.0139639.
13. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen BO. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing. 2010;39(2):203-209. doi:10.1093/ageing/afp 221.
14. Pedersen AB, Ehrenstein V, Szépligeti SK, et al. Thirty-five–year trends in first-time hospitalization for hip fracture, 1-year mortality, and the prognostic impact of comorbidity: a Danish nationwide cohort study, 1980–2014. Epidemiology. 2017;28(6):898-905. doi:10.1097/EDE.0000000000000729.
15. Van de Ree CL, Gosens T, Van der Veen AH, et al. Development and validation of the Brabant Hip Fracture Score for 30-day and 1-year mortality. Hip Int. 2020;30(3):354-362. doi:10.1177/1120700019836.
16. Smith T, Pelpola K, Ball M, et al. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age ageing. 2014;43(4):464-471. doi:10.1093/ageing/afu065.
17. Xing F, Luo R, Chen W, Zhou X. The risk-adjusted Charlson Comorbidity Index as a new predictor of one-year mortality rate in elderly Chinese patients who underwent hip fracture surgery. Ortop Traumatol Surg Res. 2021;107(3):102860. doi:10.1016/j.otsr.2021.102860.
18. Choi JS, Noh J, Kim YC, et al. Recalibration and validation of the Charlson Comorbidity Index in an asian population: The national health ınsurance service-national sample cohort study. Sci Rep. 2020;10(1). doi:10.1038/s41598-020-70624-8.
19. Kilinç G, Karakuş Ö, Gürer B. The role of ASA score and Charlson Comorbidity Index in predicting in-hospital mortality in geriatric hip fracture patients. Eur Rev Med Pharmacol Sci. 2023;27(15). doi:10.26355/eurrev_202308_33279.
20. Kilci O, Un C, Sacan O, et al. Postoperative mortality after hip fracture surgery: a 3 years follow up. PLoS One. 2016;11(10):e0162097. doi:10.1371/journal.pone.0162097.
21. Özel M, Altıntaş M, Tatlıparmak AC. Predictors of one-year mortality following hip fracture surgery in elderly. Peer J. 2023;11:e16008. doi:10.7717/peerj.16008.
22. Manosroi W, Atthakomol P, Isaradech N, et al. Preoperative correction of low hemoglobin levels can reduce 1-year all-cause mortality in osteoporotic hip fracture patients: a retrospective observational study. Clin Interv Aging. 2022;165-73. doi:10.2147/CIA.S354519.
23. Long A, Yang D, Jin L, et al. Admission inflammation markers influence long‐term mortality in elderly patients undergoing hip fracture surgery: a retrospective cohort study. Orthop Surg. 2014;16(1):38-46. doi:10.1111/os.13932.
24. Chen X, Zhang J, Liu Z, et al. Risk factors for postoperative mortality at 30 days in elderly Chinese patients with hip fractures. Osteoporos Int. 2022;33(5):1109-1116. doi:10.1007/s00198-021-06257-y.
25. Bhonsle HS, Korwar AM, Kote SS, et al. Low plasma albumin levels are associated with increased plasma protein glycation and HbA1c in diabetes. J Proteome Res. 2012;11(2):1391-1396. doi:10.1021/pr201030m.
26. Mendez CM, McClain CJ, Marsano LS. Albumin therapy in clinical practice. Nutr Clin Pract. 2005;20(3):314-320. doi:10.1177/0115426505020003314.
27. Kremer H, Baron-Menguy C, Tesse A, et al. Human serum albumin improves endothelial dysfunction and survival during experimental endotoxemia: concentration-dependent properties. Crit Care Med. 2011;39(6):1414-1422. doi:10.1097/CCM.0b013e318211ff6e.
28. Zhu L, Chen M, Lin X. Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis. Biosci Rep. 2020;40(1):BSR20190881. doi:10.1042/BSR20190881.
29. Hartopo AB, Gharini PPR, Setianto BY. Low serum albumin levels and in-hospital adverse outcomes in acute coronary syndrome. Int Heart J. 2010;51(4):221-226. doi:10.1536/ihj.51.221.
30. Königsbrügge O, Posch F, Riedl J, et al. Association between decreased serum albumin with risk of venous thromboembolism and mortality in cancer patients. Oncologist. 2016;21(2):252-257. doi:10.1634/theoncologist.2015-0284.