A linear regression model can estimate hip fracture incidence

Oldest old hip fracture patients: centenarians as the lowest complexity patients

BACKGROUND

Hip fracture leads to an increase in mortality and deterioration in the quality of life. The increase in life expectancy results in an increase in the number of oldest old patients.

AIMS

To analyze the characteristics of centenarian hip fracture patients and compare them with younger hip fracture patients.

METHODS

Retrospective study, including 176 patients (48 centenarians, 65 nonagenarians and 63 octogenarians) undergoing surgery after hip from 2009 to 2018 and followed for 1-year survival. Qualitative variables were compared by Chi-square test and quantitative variables, by Kruskal-Wallis test. Survival analysis was performed by Kaplan-Meier test and statistical differences were assessed by log-rank test. p value < 0.05 was considered statistically significant.

RESULTS

Centenarians showed the lowest Charlson index (p = 0.001), cognitive impairment (p < 0.001), and daily drug intake (p = 0.034). The in-hospital, 30-day and 1-year mortality rates did not show statistical significant differences. The 1-year survival analysis showed that patients died in order of age (p = 0.045). No differences were found regarding readmissions.

DISCUSSION

Hip fracture incidence in centenarians is increasing. Our study states the lowest complexity for centenarians. Hip fracture mortality rates have been linked to patients' age. In-hospital mortality rate has been reduced, and for the 30-day and 1-year mortality rates, we noted that mortality follows a pattern clearly related to age.

CONCLUSIONS

Centenarians showed the lowest comorbidity and complexity. Readmissions before 1 year, mortality rates at discharge, 30-day and 1-year follow-up were not significantly different, but 1-year survival analysis showed that patients are dying as they are ageing.

Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models

Objective

To investigate the clinical efficacy of three different healthcare models (Traditional Model, Geriatric Consultant Model, and Orthogeriatric Unit Model) consecutively applied to a single academic center (University Hospital of Salamanca, Spain) for older hip fracture patients.

Methods

We performed a retrospective study, including 2741 hip fracture patients older than 64 years, admitted between 1 January 2003 and 31 December 2014 to the University Hospital of Salamanca. Patients were divided into three groups according to the healthcare model applied. There were 983 patients on the Traditional Model, 945 patients on the Geriatric Consultant Model, and 813 patients on the Orthogeriatric Unit Model. We recorded age and gender of patients, functional status at admission (Barthel Index, Katz Index, and Physical Red Cross Scale), type of fracture, and intervention, and we analyzed the length of stay, time to surgery, post‐surgical stay, and in‐hospital mortality according to the healthcare model applied.

Results

Hip fractures are much more frequent in women, and an increase in the average age of patients was observed along with the study (P < 0.001). The most common type of fracture in the three models studied was an extracapsular fracture, for which the most common surgical procedure used was osteosynthesis. On the functional status of patients, there were no differences on the ambulatory ability previous to fracture, measured by the Physical Red Cross Scale, and the percentage of patients with a slight dependence determined by the Barthel Index (>60) was similar in both groups, but considering the Katz Index, the percentage of patients with a high degree of independence (A‐B) was significantly higher for the group of patients treated on the Orthogeriatric Unit Model period (56%, P = 0.009).

The Orthogeriatric Unit Model registered the greatest percentage of patients undergoing surgery (96.1%, P < 0.001) and the greatest number of early surgical procedures (<24 h) (24.8%, P < 0.001). The orthogeriatric unit model showed the shortest duration of stay (9 days median), decreasing by one day in respect of each of the other models studied (P < 0.001). Time to surgery was also significantly reduced with the Orthogeriatric Unit Model (median of 3 days, P < 0.001). With regard to in‐hospital follow‐up, there was a reduction in in‐hospital mortality during the study period. We observed differences among the three healthcare models, but without statistical significance.

Conclusions

The healthcare model based on an Orthogeriatric Unit seems to be the most efficient, because it reaches a reduction in time to surgery, with an increased number of patients surgically treated on in the first 24 h, and the greatest frequency of surgically‐treated patients.

The impact of antithrombotic therapy on surgical delay and 2-year mortality in older patients with hip fracture: a prospective observational study

PURPOSE

To analyze the associations of oral anticoagulant and antiplatelet treatments in older patients requiring surgical treatment for hip fracture with mortality, length of stay, waiting time to surgery and postsurgical immediate complications.

METHODS

A prospective observational study, including surgically treated hip fracture patients aged 65 years and older. We analyzed admission status variables, and time to surgery, length of stay and immediate surgical and medical complications. We recorded a 2-year survival follow-up.

RESULTS

Of the 237 patients studied, 32.5% received antiplatelet treatment and 17.7% received oral anticoagulant treatment. The overall 2-year mortality was 29.1%. The 2-year mortality rate reached the 33.8% for antiplatelet-treated patients (n.s.) and 45.2% for oral anticoagulated patients (p = 0.011). The length of stay increased significantly associated with the oral anticoagulant or high-dose antiplatelet treatment (p < 0.001). The same happened for the time to surgery (p < 0.001), but no delay was observed for patients with low-dose antiplatelet treatment. Oral anticoagulated and antiplatelet-treated patients had a higher Charlson comorbidity index (p = 0.004, p = 0.019) and ASA score (p = 0.006, p = 0.011). Those treatments were also associated with a higher rate of some immediate postsurgical medical complications. We found a relationship between low hemoglobin at admission and high-dose antiplatelet treatment (p = 0.044).

CONCLUSIONS

Hip fracture patients following previous oral anticoagulant treatment have a higher 2-year mortality rate. The oral anticoagulant or high-dose antiplatelet treatments are significantly associated with an increase in the length of stay, related to time to surgery, but we could not demonstrate an effect on early mortality.