Influence of risk factors for hip injuries and effect of co-morbidities on postoperative complications and outcome after hip fracture surgery in the elderly

Abstract

Background: Older adults who sustain hip fractures usually have multiple comorbidities that may impact their treatment and outcome. This study aims to analyze the risk factors that contribute to falls in elders and analyze the effect of comorbidities on the outcome and the treatment decision-making in elderly patients with hip fractures. Materials and Methods: This cohort study was conducted on patients with hip fractures. We prospectively analyzed 140 cases of geriatric hip fractures who had undergone surgery. The Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA) of each geriatric hip fracture patient were calculated based on data retrieved from the medical records. Clinical assessment was assessed using a modified Harris hip score during each visit. Results: The mean age of patients was 72.21 ± 12.2 years. The mean CCI was 1.02 ± 0.3, and ASA was 2.0 ± 0.53, and both were significantly associated with time-to-surgery (P < 0.001) and surgical treatment (P < 0.001). The length of hospital stay, duration of postoperative intensive care, and hospital expenses were associated with both CCI (P = 0.037) and ASA (P = 0.002). Greater the CCI and ASA, more chances of developing postoperative complications (χ2 = 15.724, P = 0.001). Delirium is the most common postoperative complication 15.7%, and pulmonary infection 11.4% is the most lethal complication. Conclusions: Patients with high CCI, ASA grading, and revision surgery are at high risk of developing postoperative complications, morbidity, and mortality. With efficient medical co-management of these patients, orthogeriatric care offers the best chance for a successful outcome.

Keywords

• american society of anesthesiologists grading
• charlson comorbidity index
• comorbidity
• decision making
• geriatric hip fracture