Factors associated with mortality in older patients sustaining pelvic or acetabular fractures

Abstract

Introduction: This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures.

Materials and methods: A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72 h and after 72 h. Kaplan-Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models.

Results: Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery (fracture fixation within or greater than 72 h), there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72 h were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index (CCI) and pre-op mobility status were associated with statistically significant differences in overall mortality. The same factors were associated with a significantly increased hazard of death in the multivariate Cox proportional hazards model. Patient gender, mechanism of injury, Injury Severity Score (ISS) > 15 and head injury were not significant predictors of mortality.

Conclusion: Surgical intervention within 72 h of injury did not result in decreased mortality in older patients with PA fractures. The 1-year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach between orthogeriatric and expert PA surgeons for these patients.

Keywords: Acetabular fracture; Geriatric trauma; Mortality; Pelvic fracture.

Fig. 1

Inclusion/exclusion flow diagram

Fig. 2

Graph showing the Kaplan–Meier Survival curve for patients grouped into older and elderly

Fig. 3

Graph showing the Kaplan–Meier Survival curve for patients split by CCI

Fig. 4

Graph showing the Kaplan–Meier Survival curve for patients grouped according to pre-op mobility status

Fig. 5

Graph showing the Kaplan–Meier Survival curve for patients grouped according to time to surgery below and above 72 h