ktd Kocatepe Tıp Dergisi 3061-9904 Afyonkarahisar Sağlık Bilimleri Üniversitesi 10.18229/kocatepetip.368682 Health Care Administration Sağlık Kurumları Yönetimi HIP FRACTURES TREATED WITH HEMIARTHROPLASTY: INDICATORS OF MORTALITY IN PATIENTS OLDER THAN 85 YEARS HEMİARTROPLASTİ İLE TEDAVİ EDİLMİŞ 85 YAŞ ÜSTÜ HASTALARDAKİ KALÇA KIRIKLARINDA MORTALİTE GÖSTERGELERİ Tahta Mesut Öztürk Tahir Özcan Cem Bulut Tuğrul Zengin Eyüp Çağatay Şener Muhittin 10 16 2017 18 4 141 145 08 24 2016 07 03 2017 Copyright © 1999, Kocatepe Tıp Dergisi 1999 Kocatepe Tıp Dergisi

OBJECTIVE: The aim of this study was to determine thepreoperative risk factors of all-cause mortality in thesmall but very challenging group of hip fracture patientsaged over 85 years.MATERIALS AND METHODS: Data was gathered retrospectivelyon patients aged over 85 years with a diagnosisof hip fracture. Subsequent survival was determined.The date of death was recorded (If present). The selectedpatients were separated into 2 groups: Group1 who haddied within 1 year (n=46) and group2 who had survived(n=83).The two groups were compared in respect of age,gender, operating time, the time from initial trauma tosurgery, total hospitalization duration, American Societyof Anesthesiologists score, cardiac ejection fraction, typeof fracture, application of cemented or uncementedprosthesis and number of comorbid diseases.RESULTS: The mean age of the patients in Group 1 wasdetermined to be significantly higher (p=0.011). The rateof male mortality was significantly higher (p=0.047). Therate of mortality of patients with cemented hemiarthroplastywas significantly higher (p=0.038). No differencewas determined between the groups in respect of meanASA scores (p=0.352), total hospitalization duration(p=0.120),the time from trauma to surgery (p=0.531) orejection fraction (p=0.484). No significance was determinedbetween the groups in respect of the presence andnumber of comorbid diseases.CONCLUSIONS: The mortality rate of older male patientsaged over 85 years with cemented prosthesis applied forhip fracture was higher. As the only parameter, which canbe modified, uncemented systems, should be selected, ifpossible for the prosthesis to be used.

AMAÇ: Bu çalışmada ortopedik cerrahlar açısından zorlayıcıbir popülasyon olan 85 yaş üstündeki hastalardakikalça kırığı olgularında, mortalite riskinin tespiti için preoperatifrisk faktörlerinin belirlenmesi amaçlanmıştır.GEREÇ VE YÖNTEM: Kalça kırığı tanısıyla servisimizeyatırılarak tedavi ve takip edilen 85 yaş üstündekihastaların bilgileri hastane kayıtlarından retrospektifolarak toplandı. Hastaların sağkalım durumları vehayatını kaybetmişse ölüm tarihleri tespit edildi.Seçilmiş hastalardan hayatını kaybeden 46 hasta grup 1olarak adlandırılırken; sağ kalan 83 hasta grup 2 olarakadlandırıldı. Her iki grup yaş, cinsiyet, ameliyat süresi,ameliyat olana kadar geçen süre, hastanede toplamyatış süresi, American Society of Anesthesiologists skoru,kardiyak ejeksiyon fraksiyonu (EF), kırık tipi, protezinçimentolu / çimentosuz olarak uygulanması ve komorbidfaktör varlığı ile sayıları açısından karşılaştırıldı.BULGULAR: Grup 1’deki hastaların yaş ortalaması dahayüksekti ve istatistiksel olarak anlamlı idi (p=0.011). Erkeklerdekiölüm oranı daha yüksekti ve istatistiksel olarakanlamlı idi (p=0.047). Çimentolu hemiartroplasti uygulanmışolanlarda ölüm oranı daha yüksekti ve istatistikselolarak anlamlı idi (p=0,038). İki grup arasında ASA skoruortalamaları (p=0.352), toplam yatış süresi (p=0.120), yatıştanameliyat olana kadar geçen süre (p=0.531), ejeksiyonfraksiyonları (p=0.484) açısından anlamlı fark yoktu.SONUÇ: Yaşlı, erkek ve çimentolu protez kullanılmış olan85 yaş üstü kalça kırıklı hastalarda ölüm oranları dahayüksektir ve bu hastalarda takip ve tedavide daha dikkatliolunmalı, tek modifiye edilebilir değişken olan protezkullanımında mümkünse çimentosuz sistemler tercihedilmelidir.

 Kalça kırıkları Mortalite Elderly Hip fractures Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 2007;335(7632):1251–4. Haleem S, Lutchman L, Mayahi R, Grice JH, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 2008;39(10):1157–63. Osnes EK, Lofthus CM, Meyer HE, Falch JA, Nordsletten L, Cappelen I et al. Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 2004;15(7):567– 74 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(6):676–85 Carpintero P, Lopez P, Leon F, Lluch M, Montero M, Aguilera C. Men with hip fractures has poorer nutritional status and survival than women: a prospective study of 165 patients. Acta Orthop 2005;76(3):331–5 Holvik K, Ranhoff AH, Martinsen MI, Solheim LF. Predictors of mortality in older hip fracture in patients admitted to an orthogeriatric unit in Oslo, Norway. J Aging Health 2010;22(8):1114–31. Hommel A, Ulander K, Bjorkelund KB, Norrman PO, Wingstrand H, Thorngren KG. Influence of optimized treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury 2008;39(10):1164–74 Jamal Sepah Y, Umer M, Khan A, Ullah Khan Niazi A. Functional outcome, mortality and in-hospital complications of operative treatment in elderly with hip fractures in the developing world. Int Orthop 2010;34(3):431–5. Holt G, Smith R, Duncan K, Hutchison JD, Gregori A. Outcome after surgery for the treatment of hip fracture in the extremely elderly. J Bone Joint Surg Am 2008;90(9):1899-905 Dorr L, Faugere M, Mackel A. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993;14(3):231–42 Alegre-López J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernández-Melón. Factors associated with mortality and functional disability after hip fracture: an inception cohort study. J Osteoporos Int 2005;16(7):729-36 Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Survival experience of aged hip fracture patients. Am J Public Health 1989;79(3):274-8 Panula J, Pihlajamäki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord 2011;20(12):105. Oliver CW, Burke C. Hip fractures in centenarians. Injury 2004;35(10):1025-30 Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 2005;87(3):483-9. Al-Ani AN, Samuelsson B, Tidermark J, Norling A, Ekström W, Cederholm T et al. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am 2008;90(7):1436-42. 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):146-54. Parker MI, Pryor G, Gurusamy K. Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures: A randomised controlled trial in 400 patients. J Bone Joint Surg Br 2010;92(1):116-22 Khan RJ, MacDowell A, Crossman P, Keene GS. Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip--a systematic review. Injury 2002;33(1):13-7 Anderson GH, Dias JJ, Hoskinson J, Harper WM. A randomized study of the use of bone cement with Thompson’s prosthesis in the treatment of intracapsular fractures of the femoral neck. J Bone Joint Surg 1992;74(3):132–3. Muirhead-Allwood W, Hutton P, Glasgow MMS. A comparative study of cemented and uncemented Thompson prostheses. J Bone Joint Surg 1983(10); 65: 218–9. Lennox IAC, McLauchlan J. Comparing the mortality and morbidity of cemented and uncemented hemiarthroplasties. Injury 1993;24(3):185–6. Voskuijl T, Hageman M, Ring D. Higher Charlson Comorbidity Index Scores are associated with readmission after orthopaedic surgery. Clin Orthop Relat Res 2014;472(5):1638-44. Liu Y, Peng M, Lin L, Liu X, Qin Y, Hou X. Relationship between American Society of Anesthesiologists (ASA) grade and 1-year mortality in nonagenarians undergoing hip fracture surgery. Osteoporos Int 2015;26(3):1029-33. Meyer HE, Tverdal A, Falch JA, Pedersen JI. Factors associated with mortality after hip fracture. Osteoporos Int 2000;11(3):228- 32.