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Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study

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Abstract

This study was performed to assess the impact of age of ≥ 90 years on predicting postoperative complications. We retrospectively identified all patients aged ≥ 65 years who underwent surgical repair of hip fractures over a 4.5-year period in our hospital. In total, 261 patients were identified (mean age, 86.2 ± 6.8 years). Ninety-one patients were aged ≥ 90 years (oldest-old group), and the remaining 170 were aged < 89 years (control old group). Postoperative complications developed in 54 of 261 patients (20.7%). The oldest-old group had a significantly higher proportion of patients with a Japanese long-term care insurance need level and trochanteric fracture than the control group. Spinal anesthesia was more frequently performed in the oldest-old group. After propensity adjustment for these characteristics, postoperative complication rates in the oldest-old group remained significantly higher than those in the matched control group (odds ratio (OR) 2.76, 95% confidence interval (95% CI) 1.24–6.49; P = 0.011). Major complications also developed more frequently in the oldest-old group than control group (OR 9.78, 95% CI 1.31–4.36; P = 0.018). Anesthesiologists and surgeons should pay attention to potential complications following hip fracture surgery for patients aged ≥ 90 years regardless of American Society of Anesthesiologists class or social dependency.

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References

  1. Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, Sabaté S, Mazo V, Briones Z, Sanchis J, ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113:1338–50. https://doi.org/10.1097/ALN.0b013e3181fc6e0a.

    Article  PubMed  Google Scholar 

  2. Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–9.

    Article  PubMed  Google Scholar 

  3. Xu L, Yu C, Jiang J, Zheng H, Yao S, Pei L, Sun L, Xue F, Huang Y. Major adverse cardiac events in elderly patients with coronary artery disease undergoing noncardiac surgery: a multicenter prospective study in China. Arch Gerontol Geriatr. 2015;61:503–9. https://doi.org/10.1016/j.archger.2015.07.006.

    Article  PubMed  Google Scholar 

  4. Hagino H, Endo N, Harada A, Iwamoto J, Mashiba T, Mori S, Ohtori S, Sakai A, Takada J, Yamamoto T. Survey of hip fractures in Japan: recent trends in prevalence and treatment. J Orthop Sci. 2017;22:909–14. https://doi.org/10.1016/j.jos.2017.06.003.

    Article  PubMed  Google Scholar 

  5. Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med. 2014;174:1273–80. https://doi.org/10.1001/jamainternmed.2014.2362.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Miller BJ, Callaghan JJ, Cram P, Karam M, Marsh JL, Noiseux NO. Changing trends in the treatment of femoral neck fractures: a review of the american board of orthopaedic surgery database. J Bone Joint Surg Am. 2014;96:e149. https://doi.org/10.2106/jbjs.m.01122.

    Article  PubMed  Google Scholar 

  7. Kadowaki M, Kono M, Nishiguchi K, Kakimaru H, Uchio Y. Mortality in patients with hip fracture aged over 90 years: a report from a progressively aging island. Arch Gerontol Geriatr. 2012;54:e113–7. https://doi.org/10.1016/j.archger.2011.10.003.

    Article  PubMed  Google Scholar 

  8. Cheung MY, Ho AW, Wong SH. Operative outcome of Hong Kong centenarians with hip fracture. Hong Kong Med J. 2017;23:63–6. https://doi.org/10.12809/hkmj164823.

    Article  PubMed  CAS  Google Scholar 

  9. Ouchi Y, Rakugi H, Arai H, Akishita M, Ito H, Toba K, Kai I. Joint Committee of Japan Gerontological Society (JGLS) and Japan Geriatrics Society (JGS) on the definition and classification of the elderly, Redefining the elderly as aged 75 years and older: proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int. 2017;17:1045–7. https://doi.org/10.1111/ggi.13118.

    Article  PubMed  Google Scholar 

  10. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8. https://doi.org/10.1038/bmt.2012.244.

    Article  CAS  Google Scholar 

  11. Fields AC, Dieterich JD, Buterbaugh K, Moucha CS. Short-term complications in hip fracture surgery using spinal versus general anaesthesia. Injury. 2015;46:719–23. https://doi.org/10.1016/j.injury.2015.02.002.

    Article  PubMed  Google Scholar 

  12. Karres J, Kieviet N, Eerenberg JP, Vrouenraets BC. Predicting early mortality after hip fracture surgery: the hip fracture estimator of mortality Amsterdam. J Orthop Trauma. 2018;32:27–33. https://doi.org/10.1097/BOT.0000000000001025.

    Article  PubMed  Google Scholar 

  13. Endo A, Baer HJ, Nagao M, Weaver MJ. Prediction model of in-hospital mortality after hip fracture surgery. J Orthop Trauma. 2018;32:34–8. https://doi.org/10.1097/BOT.0000000000001026.

    Article  PubMed  Google Scholar 

  14. Merchant RA, Lui KL, Ismail NH, Wong HP, Sitoh YY. The relationship between postoperative complications and outcomes after hip fracture surgery. Ann Acad Med Singapore. 2005;34:163–8.

    PubMed  CAS  Google Scholar 

  15. Fu MC, Boddapati V, Gausden EB, Samuel AM, Russell LA, Lane JM. Surgery for a fracture of the hip within 24 hours of admission is independently associated with reduced short-term post-operative complications. Bone Joint J. 2017;99-B:1216–22. https://doi.org/10.1302/0301-620x.99b9.bjj-2017-0101.r1.

    Article  PubMed  CAS  Google Scholar 

  16. Nakamura M, Kamei M, Bito S, Migita K, Miyata S, Kumagai K, Abe I, Nakagawa Y, Nakayama Y, Saito M, Tanaka T, Motokawa S. Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty: secondary analysis of a J-PSVT cohort study on anesthesia. Medicine (Baltimore). 2017;96:e6748. https://doi.org/10.1097/MD.0000000000006748.

    Article  CAS  Google Scholar 

  17. Pincus D, Ravi B, Wasserstein D, Huang A, Paterson JM, Nathens AB, Kreder HJ, Jenkinson RJ, Wodchis WP. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA. 2017;318:1994–2003. https://doi.org/10.1001/jama.2017.17606.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nishiwaki T, Nakamura K, Ueno K, Fujino K, Yamamoto M. Health characteristics of elderly Japanese requiring care at home. Tohoku J Exp Med. 2005;205:231–9.

    Article  PubMed  Google Scholar 

  19. Chen W, Fukutomi E, Wada T, Ishimoto Y, Kimura Y, Kasahara Y, Sakamoto R, Okumiya K, Matsubayashi K. Comprehensive geriatric functional analysis of elderly populations in four categories of the long-term care insurance system in a rural, depopulated and aging town in Japan. Geriatr Gerontol Int. 2013;13:63–9. https://doi.org/10.1111/j.1447-0594.2012.00859.x.

    Article  PubMed  Google Scholar 

  20. Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury. 2012;43:676–85. https://doi.org/10.1016/j.injury.2011.05.017.

    Article  PubMed  Google Scholar 

  21. Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43:464–71. https://doi.org/10.1093/ageing/afu065.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan

    Mitsuhiro Matsuo & Akiko Higuchi

  2. Department of Orthopedic Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan

    Tohru Yamagami

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  1. Mitsuhiro Matsuo
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  2. Tohru Yamagami
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  3. Akiko Higuchi
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Correspondence to Mitsuhiro Matsuo.

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Matsuo, M., Yamagami, T. & Higuchi, A. Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study. J Anesth 32, 452–456 (2018). https://doi.org/10.1007/s00540-018-2494-8

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  • DOI: https://doi.org/10.1007/s00540-018-2494-8

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