Surgical treatment of hip fracture in centenarians: Complications and independent risk factors of death

Abstract

Background: The increase in life expectancy has led to the appearance of a subgroup of hip fracture (HF) patients with special characteristics known as centenarians. The aim of the present study is to analyse the demographic characteristics, complications and mortality rate of this subgroup in order to identify the specific risk factors for mortality in these patients.

Methods: Retrospective analysis of 69 patients (58 women and 11 men) aged 100 years or older admitted to a tertiary hospital for HF between 1999 and 2018.

Results: The average age was 101.3 years (100-108, median 101). More than half (62.3%) of all patients presented with extracapsular fractures. The most common complications observed were delirium (52.3%) and urinary retention (27.7%). Haematoma (9.2%) was the most common surgical complication. Only 3 patients (7.3%) changed their place of residence after admission. In-hospital, 30-day and 1-year mortality rates were 13.8%, 21.5% and 54.2%, respectively. A high Charlson Comorbidity Index and baseline Functional Ambulation Classification (FAC) <3 were associated with a higher in-hospital mortality rate (OR = 1.95 95% CI [1.03-3.69] and OR = 5.7 95% CI [1.2-26.8]), respectively. The presence of more than 3 comorbidities and baseline FAC <3 were associated with a higher risk of 30-day mortality (OR = 6, 95% CI [1.4-24.7] and OR = 4, 95% CI [1.13-14.2]), respectively. Dementia has been associated with a higher risk of 30-day and 1-year mortality (OR = 4.6, 95% CI [1.2-16.7]) and OR = 5.11, 95% CI [1.6-21]) respectively.

Conclusion: FAC score, number of comorbidities, dementia and the Charlson Comorbidity Index have been shown to be risk factors of mortality in centenarians with HF.

Keywords: Centenarians; Hip fracture; Risk factors; Surgery: Mortality.