Analysis of Prognostic Parameters for Postoperative Mortality in Multifragmentary Hip Fracture: What is the Difference of the Re-Enablement Period?

Abstract

Objectives: Re-enablement, also called restorative care, in 5-7 days after surgery generally provides information about the outcome of anesthetic management, and in the first 30 days after surgery provides information about the quality of home care for elderly patients.The aim of this study was to determine the factors affecting mortality in patients over 60 years of age with an unstable femoral trochanteric fracture treated with a single-type of implant. Methods: Between 2015 and 2020, 268 patients with an unstable trochanteric fracture operated with a short proximal femoral nail were retrospectively evaluated. The research data were obtained from the preoperative anesthesia records and patient medical records using the electronic medical record system. The mortality data were taken from the National Population Management System. The decedents were categorized into three groups according to the period of death as those who died in the first 7 days after surgery, those who died in the first 30 days, and those who died during the entire study period.The relationship of mortality with certain factors such as sex, age, American Society of Anesthesiology (ASA)score, type of anesthesia used, Charlson comorbidity index (CCI), intensive care unit (ICU) stay, hemoglobin level, time of fracture occurrence (within or out of working hours), operation time (within or out of working hours), surgical complications, reoperations, time between fracture and entry into the operating room, need for blood support, and postoperative duration of hospital stay were assessed. Results: Non-survived patients in all groups, had a higher mean age. The patients who died in the first 30 days and throughout the study had higher CCI and ASA scores. It was observed that non-survived patients were hospitalized longer. The duration of ICU stay was significantly longer in non-survived. In our entire sample group, the time to surgery was longer in non-survived patients. More blood units were consumed by non-survived patients. The preoperative hemoglobin values of non-survived patients were significantly lower than those of the patients who survived.It was found that there was a statistically significant correlation between the patients who suffered fractures during the weekend (especially in the evening) and those who died in the first week. Apart from this, the time of fracture occurrenceand the timing of surgery had no effect on mortality. When the groups were compared according to Alzheimer's and Diabetes Mellitus, ıt has been observed that DM is not as effective as Alzheimer's on death in the first 30 days. Conclusion: There are several factors that influence mortality in geriatric patients with hip fracture, a patient group with multiple comorbidities. Our findings can be used to identify hip fracture patients who are at high risk for premature death. Knowledge of the causes of death can be utilized to improve services and develop a more didactic care pathway.