Risk factors analysis for postoperative mortality of elderly patients with femoral neck fracture undergoing hemiarthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LU Panpan ^1,2,3,4,5 , XIE Tian ^1,2,3,4,5 , DAI Guangchun ^1,2,3,4,5 , LI Yingjuan ^2,5,6 , ZOU Jihong ^2,5,6 , CHEN Hui ^1,2,3,4,5 ,  RUI Yunfeng ^1,2,3,4,5

1. Department of Orthopedic Trauma, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
2. Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
3. Trauma Center, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;
4. Orthopaedic Trauma Institute of Southeast University, Nanjing Jiangsu, 210009, P.R.China;
5. School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
6. Department of Geriatrics, Zhongda Hospital Southeast University, Nanjing Jiangsu, 210009, P.R.China;

Corresponding author：

RUI Yunfeng, Email: ruiyunfeng@126.com

Keywords：

Femoral neck fracture; the elderly; hemiarthroplasty; mortality rate; risk factor

DOI：

10.7507/1002-1892.202009122

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Objective To analyze the risk factors for postoperative mortality of the elderly patients with femoral neck fracture undergoing hemiarthroplasty.Methods Patients who underwent hemiarthroplasty for femoral neck fractures between January 2011 and December 2015 were enrolled as object. One hundred and nine patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin level and nutritional status. Univariate analysis and Cox proportional hazard regression model were used to screen the risk factors for postoperative mortality.Results The 1-year and 2-year mortalities were 6.4% (7/109) and 17.4% (19/109), respectively. Univariate analysis showed that the age, preoperative hemoglobin level and nutritional status were the influencing factors of postoperative mortality in the elderly patients with femoral neck fractures treated with hemiarthroplasty (P<0.05). Multivariate analysis showed that the age≥80 years and malnutrition were the independent risk factors for postoperative mortality (P<0.05).Conclusion To improve the clinical outcomes, perioperative risk should be comprehensively evaluated by multidisciplinary and perioperative management should be strengthened in the elderly patients with femoral neck fracture, especially those with advanced age and malnutrition, for the high postoperative mortality.

Citation： LU Panpan, XIE Tian, DAI Guangchun, LI Yingjuan, ZOU Jihong, CHEN Hui, RUI Yunfeng. Risk factors analysis for postoperative mortality of elderly patients with femoral neck fracture undergoing hemiarthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 217-220. doi: 10.7507/1002-1892.202009122 Copy

1.	Liu Y, Chen X, Zhang P, et al. Comparing total hip arthroplasty and hemiarthroplasty for the treatment of displaced femoral neck fracture in the active elderly over 75 years old: a systematic review and meta-analysis of randomized control trials. J Orthop Surg Res, 2020, 15(1): 215.
2.	Migliorini F, Trivellas A, Driessen A, et al. Hemiarthroplasty versus total arthroplasty for displaced femoral neck fractures in the elderly: meta-analysis of randomized clinical trials. Arch Orthop Trauma Surg, 2020, 140(11): 1695-1704.
3.	Cui S, Wang D, Wang X, et al. The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis. J Orthop Surg Res, 2020, 15(1): 433.
4.	Ravi B, Pincus D, Khan H, et al. Comparing complications and costs of total hip arthroplasty and hemiarthroplasty for femoral neck fractures: a propensity score-Matched, population-based study. J Bone Joint Surg (Am), 2019, 101(7): 572-579.
5.	王立强, 李洋, 刘成刚, 等. 老年股骨颈骨折患者关节置换术后病死率及危险因素分析. 中华医学杂志, 2015, 95(11): 832-835.
6.	Bzovsky S, Comeau-Gauthier M, Schemitsch EH, et al. Factors associated with mortality after surgical management of femoral neck fractures. J Orthop Trauma, 2020, 34 Suppl 3: S15-S21.
7.	O’Daly BJ, Walsh JC, Quinlan JF, et al. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures. Clin Nutr, 2010, 29(1): 89-93.
8.	Lewis DP, Wæver D, Thorninger R, et al. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplasty, 2019, 34(8): 1837-1843.
9.	Guyen O. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res, 2019, 105(1S): S95-S101.
10.	Lim YW, Kwon SY, Han SK, et al. Postoperative mortality and factors related to mortality after bipolar hemiarthroplasty in patients with femoral neck fractures. J Arthroplasty, 2009, 24(8): 1277-1280.
11.	Folbert EC, Hegeman JH, Vermeer M, et al. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment. Osteoporos Int, 2017, 28(1): 269-277.
12.	Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev, 2000, (2): CD001880.
13.	Fowler AJ, Ahmad T, Phull MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg, 2015, 102(11): 1314-1324.
14.	Kovar FM, Endler G, Wagner OF, et al. Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture—A twenty year observation study. Injury, 2015, 46(6): 1018-1022.

1. Liu Y, Chen X, Zhang P, et al. Comparing total hip arthroplasty and hemiarthroplasty for the treatment of displaced femoral neck fracture in the active elderly over 75 years old: a systematic review and meta-analysis of randomized control trials. J Orthop Surg Res, 2020, 15(1): 215.
2. Migliorini F, Trivellas A, Driessen A, et al. Hemiarthroplasty versus total arthroplasty for displaced femoral neck fractures in the elderly: meta-analysis of randomized clinical trials. Arch Orthop Trauma Surg, 2020, 140(11): 1695-1704.
3. Cui S, Wang D, Wang X, et al. The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis. J Orthop Surg Res, 2020, 15(1): 433.
4. Ravi B, Pincus D, Khan H, et al. Comparing complications and costs of total hip arthroplasty and hemiarthroplasty for femoral neck fractures: a propensity score-Matched, population-based study. J Bone Joint Surg (Am), 2019, 101(7): 572-579.
5. 王立强, 李洋, 刘成刚, 等. 老年股骨颈骨折患者关节置换术后病死率及危险因素分析. 中华医学杂志, 2015, 95(11): 832-835.
6. Bzovsky S, Comeau-Gauthier M, Schemitsch EH, et al. Factors associated with mortality after surgical management of femoral neck fractures. J Orthop Trauma, 2020, 34 Suppl 3: S15-S21.
7. O’Daly BJ, Walsh JC, Quinlan JF, et al. Serum albumin and total lymphocyte count as predictors of outcome in hip fractures. Clin Nutr, 2010, 29(1): 89-93.
8. Lewis DP, Wæver D, Thorninger R, et al. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplasty, 2019, 34(8): 1837-1843.
9. Guyen O. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res, 2019, 105(1S): S95-S101.
10. Lim YW, Kwon SY, Han SK, et al. Postoperative mortality and factors related to mortality after bipolar hemiarthroplasty in patients with femoral neck fractures. J Arthroplasty, 2009, 24(8): 1277-1280.
11. Folbert EC, Hegeman JH, Vermeer M, et al. Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment. Osteoporos Int, 2017, 28(1): 269-277.
12. Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev, 2000, (2): CD001880.
13. Fowler AJ, Ahmad T, Phull MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg, 2015, 102(11): 1314-1324.
14. Kovar FM, Endler G, Wagner OF, et al. Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture—A twenty year observation study. Injury, 2015, 46(6): 1018-1022.

Chinese Journal of Reparative and Reconstructive Surgery

Risk factors analysis for postoperative mortality of elderly patients with femoral neck fracture undergoing hemiarthroplasty

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