Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Bipolar Hemiarthroplasty for Hip Fractures in Patients Aged over 90 Years - The Factors Influencing the Postoperative Mortality -

90세 이상 고령의 고관절부 골절 환자에서 시행한 양극성 반치환술 - 사망률에 영향을 준 요인들 -

  • Chang, Jun-Dong (Department of Orthopedic Surgery, College of Medicine, Hallym University) ;
  • Yoo, Je-Hyun (Department of Orthopedic Surgery, College of Medicine, Hallym University) ;
  • Lee, Sang-Soo (Department of Orthopedic Surgery, College of Medicine, Hallym University) ;
  • Kim, Tae-Young (Department of Orthopedic Surgery, College of Medicine, Hallym University) ;
  • Jung, Kyu-Hak (Department of Orthopedic Surgery, College of Medicine, Hallym University) ;
  • Kim, Yong-Kuk (Department of Orthopedic Surgery, College of Medicine, Hallym University)
  • 장준동 (한림대학교 의과대학 정형외과학교실) ;
  • 유제현 (한림대학교 의과대학 정형외과학교실) ;
  • 이상수 (한림대학교 의과대학 정형외과학교실) ;
  • 김태영 (한림대학교 의과대학 정형외과학교실) ;
  • 정규학 (한림대학교 의과대학 정형외과학교실) ;
  • 김용국 (한림대학교 의과대학 정형외과학교실)
  • Published : 2010.12.31
⟨ Previous Next ⟩

Abstract

Purpose: We wanted to evaluate the factors that influence the one-year mortality rate after bipolar hemiarthroplasty in elderly patients over 90 years of age and who had hip fractures. Materials and Methods: In this retrospective study, we enrolled 42 cases (29 females and 12 males) that were treated by bipolar hemiarthroplasty for hip fractures between April 1999 and April 2008. The mean age was 94 (range: 90~101) years. We compared such variables as age, gender, BMD (bone mineral density), the ASA (American Society of Anesthesiologists) score, the type of fracture, the operation time, the type of anesthesia, the length of the ICU (intensive care unit) care, the length of hospitalization, operative delay and the postoperative ambulatory capability between the one-year mortality group and the control group (alive over a minimum of 1-year), and we investigated the risk factors related to one-year mortality. Results: The one-year mortality rate was 32%. There were significant relationships between the postoperative oneyear mortality and the ASA score, the length of the ICU care, operative delay and the postoperative ambulatory capability. The one-year mortality rate in the trochanteric fracture group was significantly higher than that in the neck fracture group. However, there were no relationships between the one-year mortality and age, gender, BMD, the length of operation, the type of anesthesia and the length of the hospitalization. Conclusion: The preoperative ASA score was significantly higher in the one-year mortality group among the elderly patients over 90 years of age and who were treated with bipolar hemiarthroplasty for hip fractures. The length of the ICU care, operative delay and the postoperative ambulatory capability were significantly associated with one-year mortality, and so all of these should be considered as postoperative prognostic factors.

목적: 90세 이상 고령의 고관절부 골절 환자에서 인공 고관절 반치환술 시행 후 1년 내 사망률과 관련된 인자들을 분석해 보고자 한다. 대상 및 방법: 1999년 4월부터 2008년 4월까지 90세 이상 노인 환자 중 고관절부 골절로 인공고관절 반치환술을 시행받았던 41명, 42예를 대상으로 하였으며, 평균 연령은 94세(90~101세) 였다. 술 후 1년 내 사망률을 알아보았으며, 1년 내 사망군과 1년 이상 생존군을 비교 분석하여 연령, 성별, 골절 형태, 수술의 지연, 동반 질환 수, 골밀도, ASA 등급, 수술 시간, 입원 기간, 중환자실 치료 기간, 수혈량, 마취 방법, 술 후 보행 상태와 술 후 1년 내 사망과의 관계의 유의성을 확인하였다. 결과: 90세 이상 고령의 고관절부 골절에서 인공 고관절 반치환술 후 1년 내 사망률은 32%였으며, ASA 등급, 수술의 지연, 중환자실 치료 기간 및 술 후 보행 상태가 1년 내 사망에 의미있는 영향을 미쳤다. 전자간 골절군에서 경부 골절군에 비해 1년 내 사망률이 유의하게 높았다. 성별, 골밀도, 수술 시간, 동반 질환 수, 수혈량, 재원 기간 등은 술 후 1년 내 사망에 유의한 관계가 없었다. 결론: 90세 이상 고령의 고관절부 골절 환자를 양극성 반치환술로 치료할 경우 술 전 내과적 동반 질환이 많을수록 단기간 내 사망률은 유의하게 높았다. 수술의 지연, 중환자실 치료 기간, 술 후 보행 상태 역시 1년 내 사망률과 관련이 있어 이 모두를 술 후 예후 인자로 판단해야 할 것이다.

Keywords

References

  1. Kim KH, Kho DW, Yang JH, Kim DH. Treatment of intertrochanteric fractures with bipolar hemiarthroplasty in the elderly. J Korean Soc Fractures. 2001;14:174-80. https://doi.org/10.12671/jksf.2001.14.2.174
  2. Johnell O, Nilsson B, Obrant K, Sernbo I. Age and sex pattern of hip fracture - - changes in 30 years. Acta orthop Scand. 1984;55:290-2. https://doi.org/10.3109/17453678408992358
  3. Chang JD, Kang ST, Lee EJ, Choi SJ, Chang HK, Lee CJ. A study of the factors which influence on the one-year mortality rate after hemiarthroplasty in older patients with hip fracture. J Korean Hip Soc. 1998;10:225-32.
  4. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984;186:45-56.
  5. Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am. 1995;77:1551-6. https://doi.org/10.2106/00004623-199510000-00010
  6. Jennings AG, de Boer P. Should we operate on nonagenarians with hip fractures? Injury. 1999;30:169-72. https://doi.org/10.1016/S0020-1383(98)00249-6
  7. Dahl E. Mortality and life expectancy after hip fractures. Acta Orthop Scand. 1980;51:163-70. https://doi.org/10.3109/17453678008990781
  8. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ. 1993;307:1248-50. https://doi.org/10.1136/bmj.307.6914.1248
  9. MacCollum MS 3rd, Karpman RR. Approaches to senior care #8. Hip fractures in nonagenarians. Orthop Rev. 1989;18:471-7.
  10. Aharonoff GB, Koval KJ, Skorvon ML, Zuckerman JD. Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma. 1997;11:162-5. https://doi.org/10.1097/00005131-199704000-00004
  11. Holt G, Macdonald D, Fraser M, Reece AT. Outcome after surgery for fracture of the hip in patients aged over 95 years. J Bone Joint Surg Br. 2006;88:1060-4. https://doi.org/10.1302/0301-620X.88B8.17398
  12. van de Kerkhove MP, Antheunis PS, Luitse JS, Goslings JC. Hip fractures in nonagenarians: perioperative mortality and survival. Injury. 2008;39:244-8. https://doi.org/10.1016/j.injury.2007.07.009
  13. Mullen JO, Mullen NL. Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res. 1992;280:214-22.
  14. Ooi LH, Wong TH, Toh CL, Wong HP. Hip fractures in nonagenarians--a study on operative and non-operative management. Injury. 2005;36:142-7. https://doi.org/10.1016/j.injury.2004.05.030
  15. Garden RS. Stability and union in subcapital fractures of the femur. J Bone Joint Surg Br. 1964;46:630-47.
  16. Evans EM. Trochanteric fractures; a review of 110 cases treated by nail-plate fixation. J Bone Joint Surg Br. 1951;33B:192-204.
  17. Alarcon T, Gonzalez-Montalvo JI, Barcena A, Saez P. Further experience of nonagenarians with hip fractures. Injury. 2001;32:555-8. https://doi.org/10.1016/S0020-1383(00)00244-8
  18. Hagino T, Maekawa S, Sato E, Bando K, Hamada Y. Prognosis of proximal femoral fracture in patients aged 90 years and older. J Orthop Surg. 2006;14:122-6. https://doi.org/10.1177/230949900601400203
  19. Kho DH, Kim KH, Shin JY, Lee JH, Kim DH. Postoperative mortality rate of hip fracture in elderly patients. J Korean Soc Fractures. 2006;19:117-21. https://doi.org/10.12671/jkfs.2006.19.2.117
  20. Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE. Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop. 1997;26:621-7.
  21. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239-43. https://doi.org/10.1097/00000542-197810000-00003
  22. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg Am. 1987;69:1335-40. https://doi.org/10.2106/00004623-198769090-00005
  23. Kim DS, Shon HC, Kim YM, Choi ES, Park KJ, Im SH. Postoperative mortality and the associated factors for senile hip fracture patients. J Korean Orthop Assoc. 2008;43:488-94. https://doi.org/10.4055/jkoa.2008.43.4.488
  24. Shah MR, Aharonoff GB, Wolinsky P, Zuckerman JD, Koval KJ. Outcome after hip fracture in individuals ninety years of age and older. J Orthop Trauma. 2001;15:34-9. https://doi.org/10.1097/00005131-200101000-00007
  25. Egol KA, Strauss EJ. Perioperative considerations in geriatric patients with hip fracture: what is the evidence? J Orthop Trauma. 2009;23:386-94. https://doi.org/10.1097/BOT.0b013e3181761502
  26. Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg Am. 1994;76:751-8. https://doi.org/10.2106/00004623-199405000-00018
  27. Morrison RS, Chassin MR, Siu AL. The medical consultant's role in caring for patients with hip fracture. Ann Intern Med. 1998;128:1010-20.
  28. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2001;4:CD000521.
  29. Lennox IA, McLauchlan J. Comparing the mortality and morbidity of cemented and uncemented hemiarthroplasties. Injury. 1993;24:185-6. https://doi.org/10.1016/0020-1383(93)90290-M
  30. Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br. 2009;91:922-7. https://doi.org/10.1302/0301-620X.91B7.22446
  31. Formiga F, Lopez-Soto A, Sacanella E, Coscojuela A, Suso S, Pujol R. Mortality and morbidity in nonagenarian patients following hip fracture surgery. Gerontology. 2003;49:41-5. https://doi.org/10.1159/000066501

Cited by

  1. The Analysis of Postoperative Mortality after Bipolar Hemiarthroplasty for Hip Fractures in the Elderly vol.25, pp.4, 2010, https://doi.org/10.5371/hp.2013.25.4.267
  2. The Influence of Stroke on Postoperative Prognosis of Femoral Intertrochanteric Fractures vol.51, pp.4, 2010, https://doi.org/10.4055/jkoa.2016.51.4.273
  3. Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures vol.45, pp.3, 2010, https://doi.org/10.5535/arm.21110