MORTALITY PREDICTOR IN ELDERLY PATIENTS AFTER PROXIMAL THIRD FEMUR FRACTURE: ANALYSIS OF 395 CASES

Machado, Jean Klay Santos; Santos, Eduardo Cezar Silva dos; Santos, Deivid Ramos dos

doi:10.1590/1413-785220253305e289995

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Original Article/Hip • Acta Ortop Bras 33 (5) • 2025 • https://doi.org/10.1590/1413-785220253305e289995 linkcopy

MORTALITY PREDICTOR IN ELDERLY PATIENTS AFTER PROXIMAL THIRD FEMUR FRACTURE: ANALYSIS OF 395 CASES

PREDITOR DE MORTALIDADE EM IDOSOS APÓS FRATURA DO TERÇO PROXIMAL DO FÊMUR: ANÁLISE DE 395 CASOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To assess the risk factors associated with mortality in elderly patients with proximal femoral fractures up to one year after the fracture.

Method: This was a prospective cohort study of patients aged 60 or older diagnosed with a proximal femoral fracture at a referral hospital in Belém, PA.

Results: 395 patients were assessed. The risk factors age≥83 years (p<0.0010), fracture-surgery time ≥ 3 days (p=0.0034), hemoglobin < 9g/dL (p<0.027), leukocytosis (p<0.00001) and pulmonary infection (p<0.0001) were statistically significant in mortality up to 12 months after the fracture.

Conclusion: It was observed that in the first year after fracture, gender, type of fracture and comorbidities were not determining factors in mortality. In this series, the mortality rate was 20.75% one year after the fracture, with pulmonary sepsis being the most frequent cause of death. Level of Evidence II; Cohort Study.

Keywords:
Aged; Mortality; Risk Factors; Femur; Fractures, Bone

	Death		Survival			Odds Ratio
Risk Factor	(n=82)	%	(n=313)	%	p-value	OR	95% CI	Mort.%
Sex					0.8858	1.1	0.5 to 1.8
Male	15	18.3	57	18.2				20.8
Women	67	81.7	256	81.8				20.7
Age group					0.0010*	2.4	1.4 to 3.8
83 years old or older*	48	58.5	118	37.7				28.9
60 to 82 years old	34	41.5	195	62.3				14.8
Fracture-surgery time					0.0034*	2.1	1.3 to 3.5
3 days or more*	44	53.7	110	35.1				28.6
Up to 2 days	38	46.3	203	64.9				15.8
Type Surgery					0.7361	1.1	0.7 to 1.8
DCS	4	4.9	24	7.7				14.3
DHS	5	6.1	20	6.4				20.0
HASTE	50	61	182	58.1				21.6
Arthroplasty*	16	19.5	87	27.8				15.5
Hemoglobin					0.0027*	2.5	1.4 4.3
HB < 9.0*	24	29.3	45	14.4				34.8
HB >= 9.0	58	70.7	268	85.6				17.8
White blood cells					<0.00001*	5.1	3.0 to 8.6
Leukocytosis	49	59.8	70	22.4				41.2
No leukocytosis	33	40.2	243	77.6				12.0
Complications					<0.0001*	5.6	3.0 to 10.1
Lung infection*	29	35.4	28	8.9				50.9
Absence	53	64.6	285	91.1				15.7
Comorbidity AS					0.3019	1.4	0.8 to 2.5
HAS present	63	76.8	220	70.3				22.3
Absence	19	23.2	93	29.7				17.0
Fracture type					0.4033	1.2	0.7 to 2.2
Colo	21	25.6	93	29.7				18.4
Subtrochanteric	8	9.8	36	11.5				18.2
Transthoracic*	53	64.6	184	58.8				22.4

	Death		Survival
	N (82)	%	N (313)	%	p-value
Garden					0.8961
With deviation	17	20.7	74	23.6
Without deviation	3	3.7	15	4.8
NSA	62	79.2	224	71.6
Evans					0.2508
Stable	8	9.8	43	13.7
Unstable	45	54.9	140	44.7
NA	29	35.4	130	41.5
Sensheimer					0.1938
IIA	0	0.0	7	2.2
IIB	4	4.9	10	3.2
IIC	0	0.0	3	1.0
IIIA	0	0.0	4	1.3
IIIB	0	0.0	6	1.9
IV	1	1.2	1	0.3
V	3	3.7	4	1.3
NSA	74	90.2	277	88.5

Variable	Coefficient	p-value	Odds ratio	95% CI
Intercept	-3.15
Age ≥ 83	1.20	<0.0001*	3.33	1.89 to 5.89
Time between fracture and surgery ≥ 3	0.56	0.0485*	1.75	1.10 to 3.07
Hemoglobin < 9	0.49	0.1404	1.64	0.85 to 3.20
Leukocytosis	1.48	<0.0001*	4.41	2.50 to 7.78
Lung infection	1.32	0.0001*	3.73	1.91 to 7.30

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