Hip Pelvis.  2013 Jun;25(2):127-134. 10.5371/hp.2013.25.2.127.

Analysis of the Risk Factors and Clinical Outcomes of Femoral Intertrochanteric Fractures in Patients over 65 Years Old

• Kim CH
• Lee KY
• Kim SS
• Lee MJ
• Wang L
• Kim HJ
• Kang JM

• KMID: 2054150
• DOI: http://doi.org/10.5371/hp.2013.25.2.127

Abstract

PURPOSE
This study examined therelationship between the clinical outcome and risk factors of intertrochanteric femoral fractures in patients over 65 years old.
MATERIALS AND METHODS
From January 2000 to March 2012, three hundred and twenty one patients older than 65 years, who underwent surgeryfor intertrochanteric femoral fractures, were evaluated. The following parameters wereanalyzed: the patient risk factors, such as age, sex, smoking, drinking history, cardiovascular disease, cerebrovascular disease and delayed days to surgery; admission day of the week; anesthetic method; operation time by perioperative care related to clinical outcome including postoperative mortality; and complications.
RESULTS
An analysis of the risk factors revealedfemale patients to have a 13% higher mortality (P=0.043). Aduration of surgerylonger than 3 hours was associated with a 29.1% and 20.8% higher mortality and complication rate, respectively (P<0.001, P=0.027). Asurgical delay of four days or more after admission wasassociated with a 20.1% and 18.8% higher mortality risk and complication rate, respectively (P<0.001, P<0.001). Smoking, drinking history, underlying disease, anesthetic method, and operation time had no significant effect on the outcome.
CONCLUSION
In addition to recognizing the importance of patient-related risk factors, modifying the operative factors, such as reducing surgical delays and method of anesthesia, can reduce the mortality and postoperative complications of intertrochanteric femoral fractures.

Keyword

Intertrochanteric fracture; Mortality

MeSH Terms

Anesthesia
Cardiovascular Diseases
Drinking
Femoral Fractures
Hip Fractures
Humans
Perioperative Care
Postoperative Complications
Risk Factors
Smoke
Smoking
Smoke

Reference

1. Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003; 51:364–370.

2. Ihn JC, Kim PT, Park IH, Kim SY, Oh CW, Kim JH. Mortality rate in older patients who have a hip fracture. J Korean Soc Fract. 1997; 10:1–7.

3. Chang JD, Kang ST, Lee EJ, Choi SJ, Chang HG, Lee CJ. A study of the factors which influence on the one-year mortality rate after hemiarthroplasty in older patients with hip fracture. J Korean Hip Soc. 1998; 10:225–232.

4. Jennings AG, de Boer P. Should we operate on nonagenarians with hip fractures? Injury. 1999; 30:169–172.

5. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ. 1993; 307:1248–1250.

6. MacCollum MS 3rd, Karpman RR. Approaches to senior care #8. Hip fractures in nonagenarians. Orthop Rev. 1989; 18:471–477.

7. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984; (186):45–56.

8. Miller CW. Survival and ambulation following hip fracture. J Bone Joint Surg Am. 1978; 60:930–934.

9. Suh YS, Kim YB, Choi HS, Yoon HK, Seo GW, Lee BI. Postoperative mortality and the associated factors in elderly patients with hip fracture. J Korean Orthop Assoc. 2012; 47:445–451.

10. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg Am. 1987; 69:1335–1340.

11. Kim SK, Hong JS, Park JH, Park JW, Kim JH. Mortality and functional recovery after bipolar hemiarthroplasty of femoral neck fractures in elderly patients. J Korean Hip Soc. 2002; 14:49–57.

12. Kho DH, Kim KH, Shin JY, Lee JH, Kim DH. Postoperative mortality rate of hip fracture in elderly patients. J Korean Fract Soc. 2006; 19:117–121.

13. Choi JC, Na HY, Lee YS, et al. Mortality after treatment of hip fracture over 80 years old. J Korean Hip Soc. 2006; 18:116–120.

14. Lee SR, Kim SR, Chung KH, et al. Mortality and activity after hip fracture: a prospective study. J Korean Orthop Assoc. 2005; 40:423–427.

15. Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ. Nutrition in orthropaedic surgery. J Bone Joint Surg Am. 1982; 64:1263–1272.

16. Eneroth M, Olsson UB, Thorngren KG. Nutritional supplementation decreases hip fracture-related complications. Clin Orthop Relat Res. 2006; 451:212–217.

17. Ceder L, Thorngren KG, Wallden B. Prognostic indicators and early home rehabilitation in elderly patients with hip fractures. Clin Orthop Relat Res. 1980; (152):173–184.

18. Kim DS, Shon HC, Kim YM, Choi ES, Park KJ, Im SH. Postoperative mortality and the associated factors for senile hip fracture patients. J Korean Orthop Assoc. 2008; 43:488–494.

19. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000; 321:1493.

20. Elmerson S, Zetterberg C, Andersson GB. Ten-year survival after fractures of the proximal end of the femur. Gerontology. 1988; 34:186–191.

21. Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am. 2008; 90:34–42.

22. Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE. Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop (Belle Mead NJ). 1997; 26:621–627.

23. Egol KA, Strauss EJ. Perioperative considerations in geriatric patients with hip fracture: what is the evidence? J Orthop Trauma. 2009; 23:386–394.

24. Davis TR, Sher JL, Porter BB, Checketts RG. The timing of surgery for intertrochanteric femoral fractures. Injury. 1988; 19:244–246.

25. Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am. 1995; 77:1551–1556.

26. Dolk T. Influence of treatment factors on the outcome after hip fractures. Ups J Med Sci. 1989; 94:209–221.