Abdominal complications after geriatric hip fracture surgery: Epidemiological analysis and identification of risk factors

Year 2025, Volume: 42 Issue: 2, 128 - 132, 30.06.2025

Elif Nur Gencer , Toygar Sağlam , Batuhan Gencer , Özgür Doğan , Sadettin Er

Abstract

Abdominal complications, such as postoperative ileus or acute cholecystitis, though not commonly encountered, represent a significant challenge in the management of patients admitted to orthopaedic wards following surgical procedures. Our objective was to assess the prevalence of abdominal postoperative complications following geriatric hip fracture surgery and to identify potential risk factors. Elderly patients with a hip fracture, and operated on by the same surgical team in 2023 were evaluated. Demographic variables such as age and gender, fracture type, and surgical procedures (proximal femoral nail vs. partial prosthesis) were recorded. Abdominal complications that only developed during initial hospitalization were investigated. Of the 97 patients included in the study, the incidence of abdominal complications following geriatric hip fracture surgery was 6.1% (6 patients). The incidence for postoperative ileus, acute cholecystitis, spleen infarction, and rectal bleeding were calculated as 2.1%, 2.1%, 1%, and 1%, respectively. Further analyses demonstrated a weak correlation between the development of abdominal complications and operation type (p=0.025, r=0.259). No correlation was observed between age, gender and fracture type and the development of abdominal complications. Abdominal complications after geriatric hip fracture surgery are rare, and require a multidisciplinary approach to management. Surgeons should be aware of this potential complication and necessary assessments should be performed before discharge, especially in patients undergoing arthroplasty.

Keywords

Arthroplasty , Abdominal complication , Acute cholecystitis , Geriatric hip fracture , Partial Prosthesis , Postoperative ileus

Ethical Statement

This study was approved by the local ethics committee: Ankara Şehir Hastanesi 1 Nolu Klinik Araştırmalar Etik Kurul Başkanlığı

Supporting Institution

Funding: The author(s) received no financial support for the research.

Thanks

None

References

• Bingol I, Kamaci S, Yilmaz ET, Oral M, Yasar NE, Dumlupinar E, et al. The epidemiology of geriatric fractures: A nationwide analysis of 1 million fractures. Injury. 2024; 55(11): 111900.
• De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Cricelli C, et al. Management of hip fracture in the older people: rationale and design of the Italian consensus on the orthogeriatric co-management. Aging clinical and experimental research. 2020; 32(7): 1393–1399.
• Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet (London, England). 1993; 341(8837): 72–75.
• Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2006; 17(12): 1726–1733.
• Güran O, Gencer B. Three different surgical positions on radiological outcomes in the proximal femoral nail: supine, lateral decubitus and traction table. European review for medical and pharmacological sciences. 2024; 28(4): 1384–1391.
• Gencer B, Doğan Ö. Consequences of the COVID-19 pandemic on fracture distribution: Epidemiological data from a tertiary trauma center in Turkey. Journal of Experimental and Clinical Medicine. 2022; 39(1): 128-133.
• Gencer B, Doğan Ö. Analyzing Mid-to-Long Term Mortality Rates and Associated Factors of Geriatric Patients with Hip Fractures during the COVID-19 Pandemic: A Single Centre Prospective Study. Acıbadem University Health Sciences Journal. 2022; 13(4): 491-497.
• Gencer B, Çamoğlu C, Doğan Ö. Clinical outcomes of cephalomedullary and static transverse proximal locking techniques in femoral intramedullary nailing in geriatric patients. Arch Basic Clin Res. 2024; 6(2): 90-95.
• Klasan A, Amic F, Dworschak P, Madzarac G, Heyse TJ, Neri T. Risk factors for ileus after hip and knee arthroplasty. International journal of colorectal disease. 2019; 34(2): 261–267.
• Parvizi J, Han SB, Tarity TD, Pulido L, Weinstein M, Rothman RH. Postoperative ileus after total joint arthroplasty. The Journal of arthroplasty. 2008; 23(3): 360–365.
• Gencer B, İbaç SE, Yeni BT, Sezer T, Doğan Ö. Surgical treatment of bilateral distal radius fractures: An analysis of epidemiological variables and outcome parameters. Arch Basic Clin Res. 2024; 6(3): 202-208.
• Çalışkan E, Doğan Ö. Synergistic Effect of Frailty And Malnutrition On Postoperative First Month Mortality And Delirium Status Among Geriatric Age Group Patients With Hip Fractures. Turkish J Geriatrics. 2019; 22(2): 140-149.
• Murphy MM, Tevis SE, Kennedy GD. Independent risk factors for prolonged postoperative ileus development. The Journal of surgical research. 2016; 201(2): 279–285.
• Chapuis PH, Bokey L, Keshava A, Rickard MJ, Stewart P, Young CJ, et al. Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Annals of surgery. 2013; 257(5): 909–915.
• Svatek RS, Fisher MB, Williams MB, Matin SF, Kamat AM, Grossman HB, et al. Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy. Urology. 2010; 76(6): 1419–1424.
• Bederman SS, Betsy M, Winiarsky R, Seldes RM, Sharrock NE, Sculco TP. Postoperative ileus in the lower extremity arthroplasty patient. The Journal of arthroplasty. 2001; 16(8): 1066–1070.
• Yuan Y, Tian W, Jin Z, Wang L, Zhu S. Cholecystitis in older patients following hip fracture: a case series and literature review. BMC geriatrics. 2023; 23(1): 694.
• Lirussi F, Nassuato G, Passera D, Toso S, Zalunardo B, Monica F, et al. Gallstone disease in an elderly population: the Silea study. European journal of gastroenterology hepatology. 1999; 11(5): 485–491.
• Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, et al. Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World journal of gastroenterology. 2008; 14(34): 5282–5289.
• Jang SY, Cha YH, Mun YS, Kim SH, Kim HY, Choy WS. Acute Cholecystitis in Elderly Patients after Hip Fracture: a Nationwide Cohort Study. Journal of Korean medical science. 2019; 34(5): e36.
• Yen CC, Wang CK, Chen SY, Gao SY, Lo HY, Ng CJ, et al. Risk assessment and prognostic analysis of patients with splenic infarction in emergency department: a multicenter retrospective study. Scientific reports. 2021; 11(1): 21423.
• Boland M, Murphy M, Murphy M, McDermott E. Acute-onset severe gastrointestinal tract hemorrhage in a postoperative patient taking rivaroxaban after total hip arthroplasty: a case report. Journal of medical case reports. 2012; 6: 129.
• Lammert F, Gurusamy K, Ko CW, Miquel JF, Méndez-Sánchez N, Portincasa P, et al. Gallstones. Nature reviews. Disease primers. 2016; 2: 16024.
• Dua A, Dua A, Desai SS, Kuy S, Sharma R, et al. Gender based differences in management and outcomes of cholecystitis. American journal of surgery. 2013; 206(5): 641–646.