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Methods: Retrospective observational study of 32 patients, older than 90 years, with fractures of the upper extremity of the femur at the University Hospital of Los Andes (Mérida Venezuela), in the period 1998-2003. Identification data, preexisting diseases, fracture classification, laboratory tests, and preoperative days and total hospitalization days were taken upon admission. Between January 2004 and May 2005, the patients who were discharged alive underwent a home visit, with a file prepared for this purpose. None of the deceased had an autopsy performed. Pathological, sub-trochanteric, and violent accident fractures were excluded.
Results: The female / male ratio was 1.7 / 1. Age 90.4 ± 4.19 years (90-105 years), the men were older (95.7 years). The proportion of trochanteric fractures over the cervical ones was 7/1. 68.8% remained hospitalized for less than 15 days. 34.4% were alive at the time of the review. Deaths in the first 6 months amount to 63.2% and 33.3% within the hospital; 45.5% for males and 36.8% for females. Of those operated on in the first five days, the fatality was 67.8%. For trochanteric fractures, mortality was 75% and for cervical ones, 67.5%. Lymphopenia was associated with deaths in 84.2%; T2 diabetes with 36.8%; anemia 89.5% and postoperative mental disorders 61.1%. Pneumonia in 63.2% was the possible cause of mortality.
Conclusion: In this age group, the following could be predictors of mortality: male sex, with trochanteric fractures, with lymphopenia, with anemia, with diabetes and with post-surgery delirium.
Ensrud KE, Ewing SK, Cawthon PM. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc. 2009;57:492–498.
Collin PG, D'Antoni AV, Loukas M, Oskouian RJ, Tubbs RS. Hip fractures in the elderly-: A Clinical Anatomy Review. Clin Anat. 2017;30(1):89-97.
Oh ES, Li M, Fafowora TM, Inouye SK, Chen CH, Rosman LM, Lyketsos CG, Sieber FE, Puhan MA. Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review. Int J Geriatr Psychiatry. 2015;30(9):900-10.
Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C. A critical review of the long-term disability outcomes following hip fracture. Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group. BMC Geriatr. 2016;16(1):158.
Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: A review. Clin Interv Aging. 2018;13:143-150.
Shah MR, Aharonoff GB, Wolinsky P, Zuckerman JD, Koval KJ. Outcome after hip fracture in individuals 90 years of age and older. J Orthop Trauma. 2001;15:34–39.
8.Kang BJ, Lee YK, Lee KW, Won SH, Ha YC, Koo KH. Mortality after hip fractures in nonagenarians. J Bone Metab. 2012;19:83–86.
Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43(4):464–471.
Lin JC, Liang WM. Mortality, readmission, and reoperation after hip fracture in nonagenarians. BMC Musculoskelet Disord. 2017;18(1):144.
National Institute of Statistics. Census. Venezuela; 2001.
Thinggaard M, McGue M, Jeune B, Osler M, Vaupel JW, Christensen K Survival Prognosis in Very Old Adults. J Am Geriatr Soc. 2016;64(1):81-8.
Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ. 1993;307:1248–1250.
Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20(10):1633-50.
Edgar Nieto, Jose Uzcategui, Luis Ochoa, Evelyn Thonon. Radiographic Analysis of Fractures of the Proximal Femur in Patients Over 50 Years Old at Hospital Universitario De Los Andes, Merida, Venezuela, 2008-2012. Int. J. of Orth. 2018;5(2):901-904.
ISSN 2311-5106 (Print), ISSN 2313-1462 (Online).
van de Kerkhove MP, Antheunis PS, Luitse JS, Goslings JC. Hip fractures in nonagenarians: perioperative mortality and survival. Injury. 2008;39(2):244-8.
Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT. Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. Am J Public Health. 2002; 92(5):858–862.
Alarcón T, González-Montalvo JI, Bárcena A, Saez P. Further experience of nonagenarians with hip fractures. Injury. 2001;32:555–558.
Ovidiu A, Stefan GT, Dragos P, Bogdan V, Dana A. Survival of nonagenarian patients with hip fracture: a cohort study. Acta Ortop Bras. 2017;25(4):132-136.
Castronuovo E, Pezzotti P, Franzo A, Di Lallo D, Guasticchi G. Early and late mortality in elderly patients after hip fracture: A cohort study using administrative health databases in the Lazio region, Italy. BMC Geriatr. 2011;11:37.
Teng Y, Teng Z, Xu S, Zhang X, Liu J, Yue Q, Zhu Y, Zeng Y. The Analysis for Anemia Increasing Fracture Risk. Med Sci Monit. 2020;26:925707.
Scheen AJ, Paquot N, Bauduceau B. Diabetes mellitus in the elderly: From the epidemiological challenge to a personalized approach. Rev Med Liege. 2014; 69(5-6):323-8.
Rubio-Rivas M, Formiga F, Grillo S, Gili F, Cabrera C, Corbella X. Lymphopenia as prognostic factor for mortality and hospital length of stay for elderly hospitalized patients. Aging Clin Exp Res. 2016;28(4):721-7.
Di Monaco M, Di Monaco R, Manca M, Cavanna A. Positive association between total lymphocyte count and femur bone mineral density in hip fractured women. Gerontology. 2002;48(3):157-61.
de Jong L, van Rijckevorsel VAJIM, Raats JW, Klem TMAL, Kuijper TM, Roukema GR. Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes. Clin Interv Aging. 2019;14:427-435.
Tantardini V, Roca F, Bahri O, Compere V, Dujardin F, Chassagne P. Intraoperative hypotension and delirium in patients with hip fracture. Geriatr Psychol Neuropsychiatr Vieil. 2020;18(1):25-33.
Zenilman ME. Delirium: an important postoperative complication. Jama. 2017; 317(1):77–78.
Mitchell R, Harvey L, Brodaty H, Draper B, Close J. One-year mortality after hip fracture in older individuals: the effects of delirium and dementia. Arch Gerontol Geriatr. 2017;72:135-141.
Hackett NJ, De Oliveira GS, Jain UK, Kim JY. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg. 2015;18:184-90.
Liu Y, Peng M, Lin L, Liu X, Qin Y, Hou X. Relations-hip between American Society of Anesthesiologists (ASA) grade and 1-year mortality in nonagenarians undergoing hip fracture surgery. Osteoporos Int. 2015; 26(3):1029-33.
Asao Y, Kasai SY, Higuchi T, Tsubaki N, Kobayashi O. Which anesthetic technique is more suitable for hip fracture surgery in patients above the age of 85, spinal or epidural?. Masui. 2005;54(6):638-42.
Gremillet C, Jakobsson JG. Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study. F1000Res. 2018; 7:1009.
Joosse P, Loggers SAI, Van de Ree CLPM, Van Balen R, Steens J, Zuurmond RG, Gosens T, Van Helden SH, Polinder S, Wil-lems HC, Van Lieshout EMM; FRAIL-HIP study group. The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study. BMC Geriatr. 2019;19(1):301.
Jones MR, Novitch MB, Hall OM, Bourgeois AP, Jeha GM, Kaye RJ, Orhurhu V, Orhurhu MS, Eng M, Cornett EM, Kaye AD. Fascia iliaca block, history, technique, and efficacy in clinical practice. Best Pract Res Clin Anaesthesiol. 2019;33(4):407-413.
Ooi LH, Wong TH, Toh CL, Wong HP. Hip fractures in nonagenarians a study on operative and non-operative management. Injury. 2005;36:142-7.
Salarbaks AM, Lindeboom R, Nijmeijer W. Pneumonia in hospitalized elderly hip fracture patients: the effects on length of hospital-stay, in-hospital and thirty-day mortality and a search for potential predictors. Injury. 2020; 51(8):1846-1850.
Tay YW, Hong CC, Murphy D. Functional outcome and mortality in nonagenarians following hip fracture surgery. Arch Orthop Trauma Surg. 2014;134(6):765-72.
Liu Y, Zhang CW, Zhao XD. Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment. BMC Musculoskelet Disord. 2020;21(1):217.
Dubljanin-Raspopović E, Marković-Denić L, Marinković J, Nedeljković U, Bumbaširević M. Does early functional outcome predict 1-year mortality in elderly patients with hip fracture? Clin Orthop Relat Res. 2013; 471(8):2703-10.
Gregory JJ, Starks I, Aulakh T, Phillips SJ. Five-year survival of nonagenarian patients undergoing total hip replacement in the United Kingdom. J Bone Joint Surg (Br) 2010; 92(9):1227–1230.