Factors associated with mortality in older patients sustaining pelvic or acetabular fractures

Anna Harrison; Alejandro Ordas-Bayon; Mukai Chimutengwende-Gordon; Mary Fortune; Daud Chou; Peter Hull; Andrew Carrothers; Jaikirty Rawal

doi:10.1007/s00402-021-03873-5

Factors associated with mortality in older patients sustaining pelvic or acetabular fractures

Arch Orthop Trauma Surg. 2022 Jul;142(7):1547-1556. doi: 10.1007/s00402-021-03873-5. Epub 2021 Apr 3.

Authors

Anna Harrison^{1

2}, Alejandro Ordas-Bayon³, Mukai Chimutengwende-Gordon³, Mary Fortune⁴, Daud Chou³, Peter Hull³, Andrew Carrothers³, Jaikirty Rawal³

Affiliations

¹ Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. anna.harrison360@gmail.com.
² School of Clinical Medicine, University of Cambridge, Cambridge, UK. anna.harrison360@gmail.com.
³ Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁴ School of Clinical Medicine, University of Cambridge, Cambridge, UK.

Abstract

Introduction: This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures.

Materials and methods: A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72 h and after 72 h. Kaplan-Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models.

Results: Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery (fracture fixation within or greater than 72 h), there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72 h were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index (CCI) and pre-op mobility status were associated with statistically significant differences in overall mortality. The same factors were associated with a significantly increased hazard of death in the multivariate Cox proportional hazards model. Patient gender, mechanism of injury, Injury Severity Score (ISS) > 15 and head injury were not significant predictors of mortality.

Conclusion: Surgical intervention within 72 h of injury did not result in decreased mortality in older patients with PA fractures. The 1-year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach between orthogeriatric and expert PA surgeons for these patients.

Keywords: Acetabular fracture; Geriatric trauma; Mortality; Pelvic fracture.

MeSH terms

Aged
Fracture Fixation
Fractures, Bone* / surgery
Hip Fractures*
Humans
Injury Severity Score
Multiple Trauma*
Neck Injuries*
Retrospective Studies
Spinal Fractures*