Influence of Comorbidities and Delay in Surgical Treatment on Mortality Following Femoral Neck Fracture

TY - JOUR

T1 - Influence of Comorbidities and Delay in Surgical Treatment on Mortality Following Femoral Neck Fracture

AU - Andruszkow, H

AU - Scharff, B

AU - Zapf, A

AU - Klein, M

AU - Lechler, P

AU - Hildebrand, F

AU - Frink, M

N1 - Georg Thieme Verlag KG Stuttgart · New York.

PY - 2013/8

Y1 - 2013/8

N2 - Background: Hip fractures typically occur in geriatric patients representing an increasing medical as well as socioeconomic challenge. Patients and Methods: In order to reveal the influence of considerable comorbidities and the time of surgery in the treatment of geriatric hip fractures we analysed patients treated between 1993 and 2008 at a level I trauma centre. Results: 654 patients with isolated hip fractures were included. Surgical treatment was performed with osteosynthetic stabilisation in 55.5 % (n = 363) and with endoprosthetic implants in 44.5 % (n = 291). The presence of pulmonary, psychiatric and metabolic/endocrinological comorbidities resulted in delayed treatment. If an early surgical treatment was performed within the first 12 hours after hospital admission, long-term survival was significantly improved (p = 0.02). A regression analysis revealed a statistical trend towards an increased mortality of 0.2 % per hour delay after hospital admission. The presence of considerable comorbidities and surgical treatment with endoprosthetic implants (odds ratio 1.611) were proven as independent mortality factors. Conclusion: The present study supports the guideline of early surgical treatment of geriatric hip fractures. Emphasising the incidence of in-hospital complications and the mortality after endoprosthetic treatment, osteosynthetic fracture stabilisation should be considered in the presence of considerable morbidity and pre-surgical immobilisation.

AB - Background: Hip fractures typically occur in geriatric patients representing an increasing medical as well as socioeconomic challenge. Patients and Methods: In order to reveal the influence of considerable comorbidities and the time of surgery in the treatment of geriatric hip fractures we analysed patients treated between 1993 and 2008 at a level I trauma centre. Results: 654 patients with isolated hip fractures were included. Surgical treatment was performed with osteosynthetic stabilisation in 55.5 % (n = 363) and with endoprosthetic implants in 44.5 % (n = 291). The presence of pulmonary, psychiatric and metabolic/endocrinological comorbidities resulted in delayed treatment. If an early surgical treatment was performed within the first 12 hours after hospital admission, long-term survival was significantly improved (p = 0.02). A regression analysis revealed a statistical trend towards an increased mortality of 0.2 % per hour delay after hospital admission. The presence of considerable comorbidities and surgical treatment with endoprosthetic implants (odds ratio 1.611) were proven as independent mortality factors. Conclusion: The present study supports the guideline of early surgical treatment of geriatric hip fractures. Emphasising the incidence of in-hospital complications and the mortality after endoprosthetic treatment, osteosynthetic fracture stabilisation should be considered in the presence of considerable morbidity and pre-surgical immobilisation.

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Femoral Neck Fractures

KW - Geriatric Assessment

KW - Germany

KW - Humans

KW - Incidence

KW - Lung Diseases

KW - Male

KW - Mental Disorders

KW - Metabolic Diseases

KW - Postoperative Complications

KW - Retrospective Studies

KW - Risk Assessment

KW - Survival Rate

KW - Treatment Outcome

KW - Waiting Lists

KW - English Abstract

KW - Journal Article

U2 - 10.1055/s-0032-1328665

DO - 10.1055/s-0032-1328665

M3 - SCORING: Zeitschriftenaufsatz

C2 - 23817802

VL - 151

SP - 338

EP - 342

JO - Z ORTHOP UNFALLCHIR

JF - Z ORTHOP UNFALLCHIR

SN - 1864-6697

IS - 4

ER -