Analysis of factors among 30-day and 1-year mortality rates in patients with borderline stable-unstable intertrochanteric hip fracture

Özet

Objective: This study aimed to evaluate the possible effects of surgical procedures on mortality and to identify the possible risk factors formortality in the management of geriatric hip fractures.Methods: A total of 191 patients (105 women and 86 men; mean age 82.26±9.681 [60-108] years) with AO/OTA 31A2.2 intertrochantericfractures and treated with sliding hip screw, proximal femoral nail, or hemiarthroplasty were included in this retrospective cohort study. Thetreatment type was decided by the responsible surgeon according to the patients’ pre-injury activity level, bone quality, and features of thefracture. Age, sex, type of fracture, type of surgery performed, American society of anesthesiology (ASA) grade, type of anesthesia, time tosurgery, type of physical therapy, length of hospital stay, and number of comorbidities were documented. We evaluated the 30-day and 1-yearmortality of patients treated with sliding hip screw (SHS), proximal femoral nail antirotation (PFN-A), or hemiarthroplasty and identified thepossible risk factors for mortality.Results: A total of 49 patients underwent SHS, 58 underwent PFN-A, and 84 underwent hemiarthroplasty. Of these, 2 patients with SHS,2 with PFN-A, and 11 with hemiarthroplasty died within 30 days after surgery, whereas 7 patients with SHS, 15 with PFN-A, and 23 withhemiarthroplasty died 1 year after surgery. The 30-day and 1-year overall mortality rates were 7.9% and 23.6%, respectively. Both the30-day and 1-year mortality risks were higher in patients undergoing hemiarthroplasty than in patients undergoing SHS (p=0.068 versus0.058). The 30-day mortality was higher in patients receiving general anesthesia than in those receiving combined spinal and epidural anesthesia (p=0.009). The 1-year mortality risk was higher in patients with ASA grade 4 than in those with grade 1 and 2 (p=0.045). Advancedage (p=0.022) and male sex (p=0.007) were also found to be the risk factors for 1-year mortality.Conclusion: We demonstrated that higher ASA grade, male sex, general anesthesia, and hemiarthroplasty procedures are associated withhigher mortality rates in elderly patients with hip fractures. Thus, we highly recommend orthopedic surgeons to consider all these factorsin the management of intertrochanteric hip fractures in the geriatric population. Level of Evidence: Level IV, Prognostic Study