Citation

Chou SE, Rau CS, Tsai YC, Hsu SY, Hsieh HY, Hsieh CH. Int. J. Surg. (London, England) 2019; 66: 48-52.

Affiliation

Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.ijsu.2019.04.010

PMID

31026517

Abstract

BACKGROUND: This study aimed to identify the risk factors and complications associated with mortality in elderly patients with femoral fracture after a fall from the ground level.

METHODS: This retrospective study reviewed data pertaining to elderly patients aged ≥ 65 years who were admitted into a Level I trauma center, between January 1, 2009 and December 31, 2017. Multivariate logistic regression analysis was performed to identify independent effects of univariate predictive variables on the occurrence of mortality.

RESULTS: Of 2,407 enrolled elderly patients, there were 42 mortal and 2,365 survival patients. A greater percentage of fatal patients than survival patients had a head injury with abbreviated injury scale (AIS) score ≥ 2 in the head/neck region (4.8% vs. 0.7%, respectively; p = 0.042). Multivariate logistic regression analysis revealed that the age (odds ration [OR] 1.1, 95% confident interval [CI] 1.0-1.1, p < 0.001), pre-existence of end-stage renal disease (ESRD) (OR 3.2, 95% CI 1.2-8.7, p = 0.023), and subarachnoid hemorrhage (SAH) (OR 12.1, 95% CI 1.3-113.9, p = 0.029) were significant independent risk factors for mortality in elderly patients with a femoral fracture resulting from a ground level fall. The patients in mortality group had a significantly higher rates of pneumonia (OR 28.6, 95% CI 14.6-55.9, p < 0.001), respiratory failure (OR 68.7, 95% CI 32.2-146.4, p < 0.001), sepsis (OR 26.3, 95% CI 10.9-63.4, p < 0.001), and pulmonary embolism (OR 14.4, 95% CI 1.6-131.6, p = 0.002) than those in the survival groups.

CONCLUSIONS: This study identified age, pre-existence of ESRD, and SAH as significant independent risk factors for mortality in elderly patients with femoral fracture in a fall. However, ESRD and SAH only contribute to the mortality in a small group of patients. In contrast, respiratory complications contributed greatly to mortality. Thus aggressive chest-protective measures are encouraged to decrease the respiratory complications associated with femoral fracture in elderly patients.

Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Language: en

Keywords

age; elderly; fall; femur; fracture; mortality; respiratory complication; trauma