Predictors for Adverse Outcome in Patients Aged 80 Years and Older Undergoing Emergent Hip Surgery

Eli Peled, Michal Barak, Yaniv Keren, Michael Soudry, Doron Norman

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DOI: 10.4236/ss.2011.210102                

Abstract

Background: Increased life expectancy results in aging of the population. One of the leading medical problems of elderly patients is hip fracture. We studied demographic, surgical and anesthetic parameters of elderly patients who underwent surgery due to osteoporotic hip fracture, to find predictors for peri-operative morbidity and mortality. Methods: This is a retrospective review of prospectively collected data of patients aged 80 years and older who underwent emergent surgery due to osteoporotic femoral neck, subcapital or pertrochanteric fractures. Data was collected on age, gender, co-morbidities, American Society of Anesthesiologists Class, number of regular medications, whether the patient was bedridden or not before the surgery, hemoglobin on admission and on discharge, type of surgery and anesthesia, duration of surgery, duration of hospitalization, post-operative morbidity and mortality. The demographic and peri-operative parameters were analyzed and matched to the post-operative complications and mortality to find predictors for adverse outcome. Results: One hundred and nine patients were included in the study, of whom 22 (20%) had post-operative complications and 10 (9.1%) died. We found an increased complication rate in patients who had chronic obstructive pulmonary disease and in patients who underwent general anesthesia. Patients who were bedridden before the surgery had increased mortality rates. No significant correlation was found between outcome and any other factors. Conclusion: Our results suggest favoring regional anesthesia in elderly patients undergoing emergent femoral neck surgery and acknowledging a higher risk in chronic pulmonary disease or bedridden patients.

Keywords

Femoral Fracture, Surgery, Orthopedics, Anesthesia, Spinal, Complications, Postoperative

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	O. Johnell and J. A. Kanis, “An Estimate of the World-wide Prevalence and Disability Associated with Osteoporotic Fractures,” Osteoporosis International, Vol. 17, No. 12, 2006, pp. 1726-1733. doi:10.1007/s00198-006-0172-4
[2]	C. Holroyd, C. Cooper and E. Dennison, “Epidemiology of Osteoporosis,” Best Practice & Research Clinical Endocrinology & Metabolism, Vol. 22, No. 5, 2008, pp. 671-685. doi:10.1016/j.beem.2008.06.001
[3]	B. Gullberg, O. Johnell and J. A. Kanis, “World-Wide Projections for Hip Fracture,” Osteoporosis International, Vol. 7, No. 5, 1997, pp. 407-413. doi:10.1007/PL00004148
[4]	M. Bhandari, H. Koo, L. Saunders, S. G. Shaughnessy, R. B. Dunlop and E. H. Schemitsch, “Predictors of In-Hospital Mortality Following Operative Management of Hip Fractures,” International Journal of Surgical Investigation, Vol. 1, No. 4, 1999, pp. 319-326.
[5]	M. Cree, C. L. Soskolne, E. Belseck, J. Hornig, J. E. Mc-Elhaney, R. Brant and M. Suarez-Almazor, “Mortality and Institutionalization Following Hip Fracture,” Journal of the American Geriatrics Society, Vol. 48, No. 3, 2000, pp. 283-288.
[6]	E. Bergeron, L. Moore, K. Fournier, C. Gravel and A. Lavoie, “Patients with Isolated Hip Fracture must be Considered for Surgery Irrespectively of their Age, Comorbidity Status and Provenance: A Statement Applicable even to Nonagerians,” Archives of Orthopedic and Trauma Surgery, Vol. 129, No. 11, 2009, pp. 1549-1555. doi:10.1007/s00402-009-0888-7
[7]	A. D. Pelavski, M. J. Colomina, M. De Miguel M. E. Marquez, C. Dolors and M. Aranda, “Demographics of Nonagenarians and Centenarians with a Hip Fracture,” Anesthesia and Analgesia, Vol. 103, No. 6, 2006, pp. 1597-1599. doi:10.1213/01.ane.0000246354.21634.30
[8]	G. G. Teng, J. R. Curtis and K. G. Saag, “Mortality and Osteoporotic Fractures: Is the Link Causal, and Is It Modifiable?” Clinical and Experimental Rheumatology, Vol. 26, No. 5, 2008, pp. S125-137.
[9]	A. F. Kramer, K. I. Erickson and S. J. Colcomb, “Exercise, Cognition, and the Aging Brain,” Journal of Applied Physiology, Vol. 101, No. 4, 2006, pp. 1237-1242. doi:10.1152/japplphysiol.00500.2006
[10]	P. E. Krumpe, R. J. Knudson, G. Parsons and K. Reiser, “The Aging Respiratory System,” Clinics in Geriatric Medicine, Vol. 1, No. 1, 1985, pp. 143-175.
[11]	H. J. Priebe, “The Aged Cardiovascular Risk Patient,” British Journal of Anaesthesia, Vol. 85, No. 5, 2000, pp. 763-778. doi:10.1093/bja/85.5.763
[12]	D. L. Schmucker, “Age-Related Changes in Liver Structure and Function: Implications for Disease?” Experimental Gerontology, Vol. 40, No. 8-9, 2005, pp. 650-659. doi:10.1016/j.exger.2005.06.009
[13]	M. Maggio, A. R. Cappola, G. P. Ceda, S. Basaria, C. W. Chia, G. Valenti and L. Ferrucci, “The Hormonal Pathway to Frailty in Older Men,” Journal of Endocrinological Investigation, Vol. 28, No. 11, 2005, pp. 15-19.
[14]	L.A. Beaupre, C. A. Jones, L. D. Saunders, D. W. Johnston, J. Buckingham and S. R. Majumdar, “Best Practices for Elderly Hip Fracture Patients. A Systematic Overview of the Evidence,” Journal of General Internal Medicine, Vol. 20, No. 11, 2005, pp. 1019-1025. doi:10.1111/j.1525-1497.2005.00219.x
[15]	L. H. Beck, “The Aging Kidney. Defending a Delicate Balance of Fluid and Electrolytes,” Geriatrics, Vol. 55, No. 4, 2000, pp. 26-28.
[16]	B. J. Rolls and P. A. Phillips, “Aging and Disturbances of Thirst and Fluid Balance,” Nutrition Reviews, Vol. 48, No. 3, 1990, pp. 137-144. doi:10.1111/j.1753-4887.1990.tb02915.x
[17]	R. Rivera and J. F. Antognini, “Perioperative Drug Therapy in Elderly Patients,” Anesthesiology, Vol. 110, No. 5, 2009, pp. 1176-1181. doi:10.1097/ALN.0b013e3181a10207
[18]	D. A. O’Hara, A. Duff, J.A. Berlin, R.M. Poses, V.A. Lawrence, E.C. Huber, H. Noveck, B.L. Strom and J.L. Carson, ” The Effect of Anesthetic Technique on Postoperative Outcomes in Hip Fracture Repair,” Anesthesiology, Vol. 92, No. 4, 2000, pp. 947-957.
[19]	M. J. Parker, S. C. Urwin, H. H. Handoll and R. Griffith, “General versus Spinal/Epidural Anaesthesia for Surgery for Hip Fractures in Adults,” Cochrane Database of Systematic Reviews, Vol. 2, 2000, p. CD000521.
[20]	N. Valentin, B. Lomholt, J. S. Jensen, N. Hejgaard and S. Kreiner, “Spinal or General Anaesthesia for Surgery of the Fractured Hip? A Prospective Study of Mortality in 578 Patients,” British Journal of Anaesthesia, Vol. 58, No. 3, 1986, pp. 284-291. doi:10.1093/bja/58.3.284
[21]	K. J. Koval, G. B. Aharonoff, A. D. Rosenberg, C. Schmigelski, R. L. Bernstein and J. D. Zuckerman, “Hip Fracture in the Elderly: The Effect of Anesthetic Technique,” Orthopedics, Vol. 22, No. 1, 1999, pp. 31-34.
[22]	G. T. Ferguson, P. M. Calverley, J. A. Anderson, C. R. Jenkins, P. W. Jones, L. R. Willits, J. C. Yates, J. Vestbo and B. Celli, “Prevalence and Progression of Osteoporosis in Patients with COPD: Results From the Towards a Revolution in COPD Health Study,” Chest, Vol. 136, No. 6, 2009, pp. 1456-1465. doi:10.1378/chest.08-3016
[23]	J. Eisler, R. Cornwall, E. Strauss, K. Koval, A. Siu and M. Gilbert, “Outcomes of Elderly Patients with Nondisplaced Femoral Neck Fractures,” Clinical Orthopaedics and Related Research, Vol. 399, 2002, pp. 52-58.
[24]	C. de Luise, M. Brimacombe, L. Pedersen and H. T. Sorensen, “Chronic Obstructive Pulmonary Disease and Mortality Following Hip Fracture: A Population-Based Cohort Study,” European Journal of Epidemiology, Vol. 23, No. 2, 2008, pp. 115-122. doi:10.1007/s10654-007-9211-5