Morbidity and mortality in the operative treatment of hip fractures in theelderly. Results of a prospective clinical study

This study was designed to determine risk factors and individual dispositio ns associated with morbidity and mortality in the operative treatment of hi p fractures in elderly patients. Patients and methods. In a prospective clinical trial,a consecutive series of 278 patients (mean age: 78.7 +/-6.2 years) with a hip fracture treated b y internal fixation or arthroalloplasty was recorded prospectively concerni ng preexistent diseases and risk factors. Based upon a multivariate analysi s the data were related to perioperative complications and mortality. A fol low-up during the first postoperative year was performed to determine morta lity rate and causes of deaths. Polymorbidity within the meaning of 3 preex istent diseases was present in 117 cases; a solitary disease was found in 2 5 patients. Only 19 patients were without significant risks representing a comorbidity of 93.2%. In 64.4% diseases of the cardiovascular system were d etected followed by diabetes mellitus (21.9%) and diseases of the respirato ry tract (20.1%). Results. In the postoperative course systemic complications were observed i n 118 patients indicating a general morbidity of 42.4%. According to the pr eexistent diseases recorded, cardiovascular complications (25.5%), obstruct ive ventilatory diseases (10.15) and pneumonias (12.2%) were the most commo n complications. During hospital stay 21 patients died (mortality: 7.6%). A total of 76 patients died during the first postoperative year correspondin g to a mortality rate of 27.3%. Postoperative complications were observed i n patients with poly-morbidity at 68.4% which differs significantly with th e morbidity of low-risk patients at 23.6% (p<0.001). Multivariate analysis revealed a combination of polymorbidity and age beyon d 78 years as significant risk factors towards morbidity and mortality. In detail, a prevalence of cardiovascular insufficiency, pulmonary disease and disturbance of renal function was found to be a significant disposition. Conclusions. During the preoperative course high risk patients should be id entified according to the data presented above in order to take all measure s necessary in critical care during the perioperative period. Furthermore, the results underline the importance of an early operative treatment within a posttraumatic period of 12-24 hours. Concerning the method of fracture s tabilization procedures allowing a primary full loading should be favoured with regard to early rehabilitation.