Juliane Carow1, John Bennet Carow1, Mark Coburn2, Bong-Sung Kim3, Benjamin Bücking4, Christopher Bliemel4, Leo Cornelius Bollheimer5, Cornelius Johannes Werner6, Jan Philipp Bach6, Matthias Knobe7. 1. RWTH Aachen University Hospital, Department of Orthopaedic Trauma, Aachen, Germany. 2. RWTH Aachen University Hospital, Department of Anaesthesiology, Aachen, Germany. 3. RWTH Aachen University Hospital, Department of Plastic Surgery, Hand Surgery - Burn Center, Aachen, Germany. 4. University Hospital Gießen and Marburg GmbH, Campus Marburg, Department of Trauma, Hand and Reconstructive Surgery, Marburg, Germany. 5. RWTH Aachen University Hospital, Department of Geriatric Medicine, Aachen, Germany. 6. RWTH Aachen University Hospital, Department of Neurology, Section of Interdisciplinary Geriatric Medicine, Aachen, Germany. 7. RWTH Aachen University Hospital, Department of Orthopaedic Trauma, Aachen, Germany. mknobe@ukaachen.de.
Abstract
PURPOSE: Despite intense research and innovations in peri-operative management, a high mortality rate and frequent systemic complications in trochanteric femoral fractures persist. The aim of the present study was to identify predictive factors for mortality and cardio-respiratory complications after different treatment methods in a ten year period at a level I trauma centre. METHODS: Retrospectively, all patients above 60 years of age with trochanteric femoral fracture between January 2000 and May 2011 were analyzed at a level I trauma centre. Demographic variables, comorbidities, and data regarding the surgical procedures, including required transfusions and post-operative complications, were evaluated, and the in-hospital mortality was recorded. The grade of osteoporosis was classified radiographically using the Singh index. RESULTS: The in-hospital mortality rate was 8.2% among 437 patients (male/female ratio = 110/327, mean age = 81 years) with extramedullary open (n = 144), intramedullary (n = 166), and extramedullary minimally invasive (n = 125) procedures. Significant influential factors on in-hospital mortality were identified with binary logistic regression analysis: an age of ≥90 years (P = 0.011), male sex (P = 0.003), a high American Society of Anesthesiologists (ASA) grade (3-5, P = 0.042), and a high osteoporosis grade (Singh index 3-1, P = 0.011). A total of 21.5% of the study population suffered cardio-respiratory complications post-operatively. The specific mortality was 28.7% (P < 0.001), which was influenced by a high ASA grade (3-5, P = 0.002) and a high transfusion rate (P = 0.004). Minimally invasive locked plating was associated with increased cardio-respiratory complications (P = 0.031). CONCLUSIONS: This study identified high patient age, distinctive comorbidities, male sex, and high osteoporosis grade as significant risk factors for increased in-hospital mortality in the treatment of trochanteric femoral fractures. Furthermore, high ASA grade and a liberal transfusion regime led to an increased incidence of cardio-respiratory complications. Patient-specific characteristics, especially osteoporosis grade and pre-existing medical conditions, may assist in the identification of high-risk patients and allow a patient-specific geriatric co-management plan.
PURPOSE: Despite intense research and innovations in peri-operative management, a high mortality rate and frequent systemic complications in trochanteric femoral fractures persist. The aim of the present study was to identify predictive factors for mortality and cardio-respiratory complications after different treatment methods in a ten year period at a level I trauma centre. METHODS: Retrospectively, all patients above 60 years of age with trochanteric femoral fracture between January 2000 and May 2011 were analyzed at a level I trauma centre. Demographic variables, comorbidities, and data regarding the surgical procedures, including required transfusions and post-operative complications, were evaluated, and the in-hospital mortality was recorded. The grade of osteoporosis was classified radiographically using the Singh index. RESULTS: The in-hospital mortality rate was 8.2% among 437 patients (male/female ratio = 110/327, mean age = 81 years) with extramedullary open (n = 144), intramedullary (n = 166), and extramedullary minimally invasive (n = 125) procedures. Significant influential factors on in-hospital mortality were identified with binary logistic regression analysis: an age of ≥90 years (P = 0.011), male sex (P = 0.003), a high American Society of Anesthesiologists (ASA) grade (3-5, P = 0.042), and a high osteoporosis grade (Singh index 3-1, P = 0.011). A total of 21.5% of the study population suffered cardio-respiratory complications post-operatively. The specific mortality was 28.7% (P < 0.001), which was influenced by a high ASA grade (3-5, P = 0.002) and a high transfusion rate (P = 0.004). Minimally invasive locked plating was associated with increased cardio-respiratory complications (P = 0.031). CONCLUSIONS: This study identified high patient age, distinctive comorbidities, male sex, and high osteoporosis grade as significant risk factors for increased in-hospital mortality in the treatment of trochanteric femoral fractures. Furthermore, high ASA grade and a liberal transfusion regime led to an increased incidence of cardio-respiratory complications. Patient-specific characteristics, especially osteoporosis grade and pre-existing medical conditions, may assist in the identification of high-risk patients and allow a patient-specific geriatric co-management plan.
Authors: Juliane Carow; John Bennet Carow; Mark Coburn; Bong-Sung Kim; Benjamin Bücking; Christopher Bliemel; Leo Cornelius Bollheimer; Cornelius Johannes Werner; Jan Philipp Bach; Matthias Knobe Journal: Int Orthop Date: 2018-01-02 Impact factor: 3.075
Authors: Pablo A Slullitel; Martín Estefan; Wilber M Ramírez-Serrudo; Fernando M Comba; Gerardo Zanotti; Francisco Piccaluga; Martín A Buttaro Journal: Int Orthop Date: 2018-03-10 Impact factor: 3.075
Authors: Adam Omari; Christian Medom Madsen; Jes Bruun Lauritzen; Henrik Løvendahl Jørgensen; Fie Juhl Vojdeman Journal: Int Orthop Date: 2019-03-23 Impact factor: 3.075
Authors: Raj M Amin; Varun Puvanesarajah; Yash P Chaudhry; Matthew J Best; Sandesh S Rao; Steven M Frank; Erik A Hasenboehler Journal: World J Orthop Date: 2021-05-18
Authors: Austin V Stone; Alexander Jinnah; Brian J Wells; Hal Atkinson; Anna N Miller; Wendell M Futrell; Kristin Lenoir; Cynthia L Emory Journal: Int Orthop Date: 2017-10-07 Impact factor: 3.479