Predicting life expectancy after geriatric hip fracture: A systematic review

Background Displaced femoral neck fractures in geriatric patients are typically treated with either hemiarthroplasty or total hip arthroplasty. The choice between hemiarthroplasty and total hip arthroplasty requires a good estimate of the patient’s life expectancy, as the recent HEALTH trial suggests that the benefits of the two operations do not diverge, if at all, until the second year post-operatively. A systematic review was this performed to determine if there sufficient information in the medical literature to estimate a patient’s life expectancy beyond two years and to identify those patient variables affecting survival of that duration. Methods Pubmed, Embase, and Cochrane databases were queried for articles reporting survival data for at least two years post-operatively for at least 100 patients, age 65 or greater, treated surgically for an isolated hip fracture. A final set of 43 papers was created. The methods section of all selected papers was then reviewed to determine which variables were collected in the studies and the results section was reviewed to note whether an effect was reported for all collected variables. Results There were 43 eligible studies with 25 unique variables identified. Only age, gender, comorbidities, the presence of dementia and fracture type were collected in a majority of studies, and within that, only age and gender were reported in a majority of the results. Most (15/ 25) variables were reported in 5 or fewer of the studies. Discussion There are important deficiencies in the literature precluding the evidence-based estimation of 2 year life expectancy. Because the ostensible advantages of total hip arthroplasty are reaped only by those who survive two years or more, there is a need for additional data collection, analysis and reporting regarding survival after geriatric hip fracture.

Hip fractures: mortality and correlation with preoperative comorbidities in Indian elderly population

<p class="abstract"><strong>Background:</strong> Hip fractures are an emerging health care problem due to increase in the elderly population all over the world and the associated complications, morbidity and mortality. The objective of this study is to find out the mortality rates in Indian elderly population with hip fractures and to establish an association between various related complications pre and post operatively for a better risk stratification.</p><p class="abstract"><strong>Methods: </strong>A prospective observational cohort study, was carried out at a high-volume orthopaedic centre from 2009 to 2018. And all patients managed for hip fractures were followed up till death or 05 years.</p><p class="abstract"><strong>Results: </strong>The age adjusted first-year mortality was found to be 33% with statistically significant increase in the mortality in individuals with three or more pre-op comorbidities. The significantly associated co-morbidities were chronic renal failure (Hazard ratio 2.32 with CI 1.65- 3.24) and diabetes mellitus (Hazard ratio 1.66 with CI 1.25 – 2.21). There has been a significant dip in the cumulative survival rates of these individuals irrespective of age, sex, preop anaemia.</p><p class="abstract"><strong>Conclusions: </strong>A knowledge about the comorbidities/ risk factors and the extent to which they influence the long-term survival in the geriatric hip fracture patients can help treating physician to effectively prioritise and plan management in coordination with allied specialities. </p>