Comparison of mortality rates and risk factors for mortality between proximal femoral nailing and bipolar hemiarthroplasty for hip fractures

Yıl 2024, , 327 - 331, 27.05.2024

Mustafa Altıntaş , Okan Ateş

https://doi.org/10.32322/jhsm.1469719

Öz

Aims: The study aimed to compare in-hospital and post-discharge mortality rates and identify risk factors for patients who underwent bipolar hemiarthroplasty (BHA) or proximal femoral nailing (PFN) for hip fractures.
Methods: The files of 395 patients, consisting of 129 BHA and 266 PFN patients performed between January 2017 and October 2022, were analyzed retrospectively. The demographic characteristics of the patients, in-hospital and 1-year post-discharge mortality rates, and risk factors that may have affected these mortality rates were analyzed.
Results: There was no significant difference between the two groups in terms of demographic characteristics, intensive care unit (ICU) stay, American Society of Anesthesiologists (ASA) score, time to surgery, and intubation (p>0.05). The length of hospital stay and blood transfusion rates were higher in the BHA group (p<0.05). There was no significant difference between the two groups regarding in-hospital and 1-year post-discharge mortality rates (p>0.05). The 1-year post-discharge mortality rates were higher for patients with a higher mean age, longer length of hospital stay, longer length of ICU stay, time to surgery (>48 h), for patients who underwent intubation and blood transfusion, and for those with an ASA score of 4 (p<0.05). Chronic obstructive pulmonary disease (COPD) and congestive heart disease (CHF) were associated with higher in-hospital and 1-year post-discharge mortality, whereas dementia was only associated with higher 1-year post-discharge mortality (p<0.05).
Conclusion: There was no significant difference between the in-hospital and 1-year post-discharge mortality rates of patients who underwent PFN and those who underwent BHA. Patients with longer time to surgery (>48 h), longer length of hospital and ICU stay, patients with an ASA score of 4, and intubated patients had higher mortality rates. Comorbid CHF, COPD, and dementia increased the mortality rate in patients.

Anahtar Kelimeler

Bipolar hemiarthroplasty, Hip fracture, proximal femoral nail, mortality

Destekleyen Kurum

Herhangi bir destek alınmamıştır

Kaynakça

• Canan Gulcan. A study on life expectancy in Turkey. EMU Journal of Pharmaceutical Sciences. 2020;3(2):86-96.
• Loggers SAI, Van Lieshout EMM, Joosse P, Verhofstad MHJ, Willems HC. Prognosis of nonoperative treatment in elderly patients with a hip fracture: a systematic review and meta-analysis. Injury. 2020;51(11):2407-2413. doi:10.1016/j.injury. 2020.08.027
• Fischer H, Maleitzke T, Eder C, Ahmad S, Stöckle U, Braun KF. Management of proximal femur fractures in the elderly: current concepts and treatment options. Eur J Med Res. 2021;26(1):86. doi:10.1186/s40001-021-00556-0
• Hongku N, Woratanarat P, Nitiwarangkul L, Rattanasiri S, Thakkinstian A. Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a systematic review and network meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res. 2022;108(1):102838. doi:10.1016/j.otsr.2021.102838
• Venkataraman Dr, E DrP, Kumar DrPM, M DrPR. Comparative study of PFN A2 vs bipolar hemiarthroplasty in unstable senile intertrochanteric fractures. International Journal of Orthopaedics Sciences. 2020;6(1):312-316. doi:10.22271/ortho.2020.v6.i1f.1880
• Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1(1):6-14. doi:10.1177/2151458510378105
• Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res. 2014;472(4):1291-1299. doi:10.1007/s11999-013-3308-9
• Görmeli G, Korkmaz MF, Görmeli CA, Adanaş C, Karataş T, Şimşek SA. Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems. Ulus Travma Acil Cerrahi Derg. 2015;21(6):503-508. doi:10.5505/tjtes.2015.96166
• Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One. 2012;7(10):e46175. doi:10.1371/journal.pone.0046175
• Owens WD, Felts JA, Spitznagel EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49(4):239-243. doi:10.1097/00000542-197810000-00003
• Çelen ZE, Gazi O. Distal fixation modular stem hemiarthroplasty versus proximal femoral nailing for unstable intertrochanteric fractures: a retrospective cohort study. Acta Orthop Belg. 2022; 88(3):599-608. doi:10.52628/88.3.9875
• Kılınç S, Pazarcı Ö. Investigating the risk factors that affect mortality after cemented hemiarthroplasty in advanced age patients. J Orthop. 2020;21:249-252. doi:10.1016/j.jor.2020.03.031
• Durgut F, Şahin E, Çiftçi S, Kerem BA. Proximal femoral nail antirotation versus cemented calcar-replacement hemiarthroplasty for unstable intertrochanteric fracture in elderly: an overall survival study. Turk J Med Sci. 2022;52(2):463-466. doi:10.55730/1300-0144.5334
• Erkmen D, Oken OF, Demirtaş Y. Comparison of calcareous replacement hemiarthroplasty and proximal femoral nail in elderly ıntertrochanteric femur fractures. Int J Res Orthop. 2023;9(5):863-869. doi:10.18203/issn.2455-4510 Int J Res Orthop. 20232462
• İpek D, Çalbiyik M, Denizci T, Aliç T, Dündar A, Zehir S. Evaluation of risk factors and outcomes associated with mortality after hip fracture surgery in eldery patients. J Health Sci Med. 2022;5(6):1693-1697. doi:10.32322/jhsm.1167524
• Pincus D, Ravi B, Wasserstein D, et al. Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery. JAMA. 2017;318(20):1994-2003. doi:10.1001/jama.2017.17606
• Uzoigwe CE, Burnand HGF, Cheesman CL, Aghedo DO, Faizi M, Middleton RG. Early and ultra-early surgery in hip fracture patients improves survival. Injury. 2013;44(6):726-729. doi:10.1016/j.injury.2012.08.025
• Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth. 2008; 55(3): 146-154. doi:10.1007/BF03016088
• Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609-1616. doi:10.1503/cmaj.092220
• McHugh MA, Wilson JL, Schaffer NE, et al. Preoperative comorbidities associated with early mortality in hip fracture patients: a multicenter study. J Am Acad Orthop Surg. 2023; 31(2):81-86. doi:10.5435/JAAOS-D-21-01055
• Barceló M, Torres OH, Mascaró J, Casademont J. Hip fracture and mortality: study of specific causes of death and risk factors. Arch Osteoporos. 2021;16(1):15. doi:10.1007/s11657-020-00873-7