Is Age Just A Number? Mortality Risk Factors for Centenarians Undergoing Hip Fracture Surgery

A new study assessed complications and risk factors for mortality among a special group of operative hip fracture patients: centenarians.

As the population continues living longer, the study authors pointed out that “the population of individuals aged over 100 years in 2016 was 558,597, twice as many as a decade ago, and half as many as the expected population in 2027. Centenarians are characterised by a high comorbidity burden, polypharmacy, and therefore, high surgical risk. According to recent studies, fractures are the third cause of hospitalisation in this age group, after infections and cardiovascular events. Advanced age has been shown to be an independent risk factor for poor prognosis and mortality after hip fracture.”

To explore outcomes in centenarians, the researchers retrospectively analyzed 69 hip fracture patients (average age, 101.3 years; 58 centenarians were female) aged 100 years or older admitted to a tertiary hospital between 1999 and 2018.

Extracapsular fractures were recorded in 62.3% of centenarians. Delirium was the most common complication, observed in just over half of patients (52.3%), followed by urinary retention (27.7%); 9.2% of patients sustained hematoma, the most common surgical complication. Following admission, three patients (7.3%) changed their place of residence. The in-hospital mortality rate was 13.8%; the 30-day and one-year mortality rates were 21.5% and 54.2%, respectively. Risk factors for in-hospital mortality among centenarians were a high Charlson Comorbidity Index (odds ratio [OR]=1.95; 95% confidence interval [CI], 1.03 to 3.69) and baseline Functional Ambulation Classification (FAC) <3 (OR=5.7; 95% CI, 1.2 to 26.8). Risk factors for 30-day mortality for centenarians were having more than three comorbidities (OR = 6; 95% CI, 1.4 to 24.7) and baseline FAC <3 (OR=4, 95% CI, 1.13 to 14.2). Dementia was a risk factor for 30-day (OR=4.6; 95% CI, 1.2 to 16.7) and one-year mortality (OR=5.11; 95% CI, 1.6-21.0) among centenarians.

The report was published in Injury.

“Because of the special baseline characteristics of centenarians, results from studies on the surgical treatment of HF in younger patients cannot reliably be extrapolated to this group. FAC scores, number of comorbidities, dementia and Charlson Comorbidity Index have been shown to be predictors mortality in our patients. More studies are needed to confirm these results,” the study authors concluded.