Comparing mortality in the elderly after proximal femur fractures and coxarthrosis: the effect of individual health characteristics and day of surgery

Abstract

Purpose: This study investigates mortality variations between elective and urgent hip surgeries, focusing surgery timing and its impact on post-operative mortality. By comparing cases of femoral neck fractures, pertrochanteric fractures, and coxarthrosis across different follow-up durations, it aims to identify factors contributing to increased mortality.

Methods: We used a random sample of German longitudinal health claims data (N = 250,000, 2004-2019) and identified 10,310 patients aged 50 years and older who underwent surgery for femoral neck fracture, pertrochanteric fracture, or coxarthrosis between 2004 and 2014. We tracked mortality at 30 days, 1 year, and 5 years. Cox proportional models were used, adjusted for the following covariates at the time of surgery: sex, age, comorbidities, nursing home dependency, discharge diagnosis, and weekday of surgery.

Results: Mortality probabilities were 5% at 30 days, 15.6% at 1 year, and 38.9% at 5 years, with significantly higher risks for fractures than coxarthrosis. Key factors influencing mortality included age, comorbidities (e.g., heart failure, stroke, myocardial infarction, dementia), and care dependency levels. Women had lower risks than men across all periods. Short-term mortality was most affected by comorbidities, while long-term mortality correlated with chronic health conditions such as nicotine abuse and diabetes mellitus, and care needs. Surgery timing showed no consistent weekday effects.

Conclusion: Mortality differences reflect the impact of acute trauma from emergency surgery rather than the surgical procedure itself, emphasizing the need for optimized planning, preparation, early treatment and adaptable care structures in an aging population.

Keywords: Cox proportional models; Coxarthrosis; Geriatric; Mortality; Proximal femur fracture; Surgery.