Hip fractures in the elderly: operative versus nonoperative management

Abstract

Introduction: Hip fractures are common in the elderly. Published studies have not shown significant differences in mortality rates between hip fracture patients who were managed nonoperatively and operatively. This retrospective study looked at 340 patients with hip fractures who were admitted to a local hospital over one year, and compared the long-term mortality between those treated operatively and nonoperatively.

Methods: All patients with hip fractures were identified retrospectively from the hospital's hip registry. Mortality data was collected through nationwide electronic medical records and telephone interviews.

Results: Overall mortality rates at one (14.4%) and two years (24.4%) were comparable to those of other studies. Hip fracture patients who were treated nonoperatively had a higher risk of mortality at both one (29.8%) and two years (45.6%) after fracture (p < 0.05). Their risk of mortality was four times higher at one year and three times higher at two years after fracture than the operative group. Patients with a higher American Society of Anesthesiologists (ASA) grade did not show an increased risk in mortality compared to patients with a lower ASA grade at both one year (p = 0.072) and two years (p = 0.360) after fracture.

Conclusion: Elderly patients with hip fractures should be managed surgically and counselled regarding the increased risk of mortality if treated nonoperatively.

Keywords: hip fracture; mortality; nonoperative management.