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Hip Fractures in Centenarians Chris Oliver DM FRCS(Tr & Orth) FRCP Chris Burke MB BS BMedSc  Edinburgh Orthopaedic Trauma ...
Centenarian hip fractures <ul><li>centenarians increased 1463% 1951 - 1991  </li></ul><ul><li>morbidity and mortality rate...
Human life expectancy
Epidemiology <ul><li>0.01% people ever reach 100 years </li></ul><ul><li>number of centenarians increasing by around 7% pe...
Age Specific Mortality
Patients and Methods <ul><li>18 centenarians </li></ul><ul><li>Standardised Audit of Hip Fractures in Europe (SAHFE) </li>...
Patients and Methods <ul><li>Four-month SAHFE follow-up form </li></ul><ul><li>Where patient had stayed (including re-admi...
Age and Sex <ul><li>“normal” 78.2 years (75-83)  </li></ul><ul><ul><li>Male: Female 1:17  </li></ul></ul><ul><li>centenari...
Mortality – hip fractures four months  <ul><li>5.6% of normal hip fractures dead  </li></ul><ul><li>50% of centenarians de...
Kaplan-Meier survival curve for the Centenarians and 75-83 year olds following proximal femoral fracture
Walking ability <ul><li>At four month follow up 44% of the surviving centenarians were wheelchair/bedbound compared to onl...
Residential status <ul><li>Centenarians are less likely than younger controls to be able to continue to live independently...
Co-morbidity factors <ul><li>Many of the patients in both age groups had co-morbidities </li></ul><ul><li>44% of the cente...
American Society of Anaesthesiologists Grade <ul><li>Number of reports claiming ASA grading system is a good predictor of ...
Total hospital stay <ul><li>LOS acute orthopaedic ward in the centenarians was 10.1 days compared to 9.7 days in the contr...
Take home message <ul><li>Largest review of proximal femoral fractures in centenarians </li></ul><ul><li>50% mortality fou...
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Hip Fractures in Centenarians

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Hip Fractures in Centenarians

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Hip Fractures in Centenarians

  1. 1. Hip Fractures in Centenarians Chris Oliver DM FRCS(Tr & Orth) FRCP Chris Burke MB BS BMedSc Edinburgh Orthopaedic Trauma Unit
  2. 2. Centenarian hip fractures <ul><li>centenarians increased 1463% 1951 - 1991 </li></ul><ul><li>morbidity and mortality rates? </li></ul><ul><li>retrospective review treatment outcomes in relation to mortality, walking ability and residential status </li></ul><ul><li>comparing centenarians with typical hip fracture population </li></ul>
  3. 3. Human life expectancy
  4. 4. Epidemiology <ul><li>0.01% people ever reach 100 years </li></ul><ul><li>number of centenarians increasing by around 7% per annum and doubling each decade </li></ul>
  5. 5. Age Specific Mortality
  6. 6. Patients and Methods <ul><li>18 centenarians </li></ul><ul><li>Standardised Audit of Hip Fractures in Europe (SAHFE) </li></ul><ul><li>1998 - 2002 </li></ul><ul><li>Data on admission to acute care, on discharge or transfer from the acute orthopaedic unit, at four months following admission and on readmission to the orthopaedic ward </li></ul><ul><li>Residential status, walking ability, type of fracture, (ASA) Grade, surgical treatment, in-hospital mortality, place to which patients were discharged </li></ul>
  7. 7. Patients and Methods <ul><li>Four-month SAHFE follow-up form </li></ul><ul><li>Where patient had stayed (including re-admissions), their residential status, walking ability, walking aids required and mortality (including date of death) within the first four months post fracture </li></ul><ul><li>Had to be 100 years or over at the time of fracture </li></ul><ul><li>Control hip fracture group age 75-83 same time period </li></ul><ul><li>Statistical evaluation of difference in four-month mortality between the two groups was performed using Fisher’s Exact test for a two by two contingency table. </li></ul><ul><li>A Kaplan-Meier survival curve was also produced to analyse the cumulative survival in the two groups post fracture </li></ul>
  8. 8. Age and Sex <ul><li>“normal” 78.2 years (75-83) </li></ul><ul><ul><li>Male: Female 1:17 </li></ul></ul><ul><li>centenarians 101.8 years (100-106) </li></ul><ul><ul><li>Male: Female 4:14 </li></ul></ul>
  9. 9. Mortality – hip fractures four months <ul><li>5.6% of normal hip fractures dead </li></ul><ul><li>50% of centenarians dead P=0.00723 </li></ul><ul><li>centenarian mortality in hospital, at one month and four months was </li></ul><ul><ul><li>11%, 33% and 50% respectively </li></ul></ul><ul><li>Forster and Calthorpe centenarian mortality in hospital, at 30 days and at six months was </li></ul><ul><ul><li>31%, 31% and 50% respectively </li></ul></ul>Forster, Calthorpe. Mortality following surgery for proximal femoral fractures in centenarians. Injury, International Journal of Care of the Injured 2000; 31: 537-539.
  10. 10. Kaplan-Meier survival curve for the Centenarians and 75-83 year olds following proximal femoral fracture
  11. 11. Walking ability <ul><li>At four month follow up 44% of the surviving centenarians were wheelchair/bedbound compared to only 6% at the time of their injury </li></ul><ul><li>43% of patients had re-gained their pre-fracture walking ability four months after hip fracture in a study of 102 patients (mean age 83 years) </li></ul><ul><ul><li>2001 van Balen </li></ul></ul>
  12. 12. Residential status <ul><li>Centenarians are less likely than younger controls to be able to continue to live independently following hip fracture and are likely to be in institutional care four months post-fracture </li></ul><ul><li>Parker reported that in Edinburgh 41% of patients (mean age 80.7 years) were discharged directly back to their place of origin </li></ul><ul><li>56% of the younger “normal” group were discharged directly back to their place of origin compared to 31% of the centenarians </li></ul><ul><li>Before injury 39% of centenarians were living independently (at their own home or in sheltered housing). Four months post fracture this had fallen to 22% </li></ul><ul><li>Of the centenarians living independently before their hip fracture only 29% were able to return to independent accommodation compared to 69% of the younger group </li></ul>
  13. 13. Co-morbidity factors <ul><li>Many of the patients in both age groups had co-morbidities </li></ul><ul><li>44% of the centenarians that died had cardiac failure </li></ul><ul><li>33% of the centenarians dead at four months were suffering from dementia </li></ul><ul><ul><li>Wood reported that 75% of those over 85 with dementia had died by six months post hip fracture </li></ul></ul><ul><li>Clear limitation in this study was MTS was not recorded </li></ul>
  14. 14. American Society of Anaesthesiologists Grade <ul><li>Number of reports claiming ASA grading system is a good predictor of mortality after hip fracture </li></ul><ul><li>Centenarians had higher ASA scores at the time of injury - 50% of centenarians had an ASA score of III-IV compared to 22% of the younger group </li></ul><ul><li>No significant association </li></ul><ul><li>Unusual - frailer patients with more co-morbidity to be more likely to die within four months of the fracture </li></ul>
  15. 15. Total hospital stay <ul><li>LOS acute orthopaedic ward in the centenarians was 10.1 days compared to 9.7 days in the control group </li></ul><ul><ul><li>identical to the mean of 9.7 days reported in a population of 1522 patients (mean age 80.7 years) admitted to Edinburgh Royal Infirmary with proximal femoral fracture between 1993 and 1995 </li></ul></ul><ul><li>mean total hospital stay in centenarians was 53.5 days compared to younger “normal” group was 22.1 days. </li></ul>
  16. 16. Take home message <ul><li>Largest review of proximal femoral fractures in centenarians </li></ul><ul><li>50% mortality four months following fracture </li></ul><ul><li>Centenarians are less likely to recover pre-fracture walking </li></ul>

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