Nonagenarians May Benefit from Increased Time to Hip Fracture Surgery

Although older adults age 90 and older have a relatively low risk of complications after hip fracture surgery overall, their risk is higher than that of older adults who are younger. Researchers published their findings online in The Journal of Arthroplasty. 

“With the shift in hip fracture epidemiology toward older individuals as well as the shift in demographics toward nonagenarians, it is important to understand the outcomes of treatment for these patients,” researchers wrote. 

The study compared 51,327 older adults ages 65 through 89 who underwent surgery for hip fracture with 15,798 nonagenarians ages 90 and older who underwent the procedure between 2005 and 2017. 

The overall rate of serious adverse events from hip fracture surgery for nonagenarians was 19.89%, compared with 14.80% in older adults younger than age 90, researchers reported. Nonagenarians had a higher risk for blood transfusion, death, pneumonia, and cardiac complications compared with younger older adults. 

Risk factors for serious adverse events in patients 90 and older included an American Society of Anesthesiologists physical status classification level of 3 or higher, dependent functional status, having been admitted to the hospital from a nursing home or chronic/intermediate care facility, preoperative hypoalbuminemia, and male gender, according to the study. 

Increased time to surgery, researchers found, was associated with a lower risk of 30-day mortality in nonagenarians. 

“Interestingly, since time to surgery was not associated with adverse outcomes in nonagenarians, the commonly accepted 48-hour operative window may not be critical to this population,” researchers wrote. “Additional time for preoperative medical optimization in this vulnerable population appears prudent.” 

—Jolynn Tumolo

Reference: 

Bovonratwet P, Yang BW, Wang Z, Ricci WM, Lane JM. Operative Fixation of Hip Fractures in Nonagenarians: Is It Safe? [published online ahead of print, 2020 Jun 9]. J Arthroplasty. 2020;S0883-5403(20)30645-8. doi:10.1016/j.arth.2020.06.005