Influence of Risk Factors and Comorbidities on Postoperative Complications and Outcomes after Hip Fracture Surgery in the Elderly

Khazi Syed Asif Hussain; Aluka Sundeep Kund Reddy; Mayani Raju; Chandrashekhar Patnala

doi:10.18502/jost.v8i4.10452

Khazi Syed Asif Hussain Additional Professor, Department of Orthopedics, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
Aluka Sundeep Kund Reddy Associate Professor, Department of Orthopedics, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
Mayani Raju Senior Resident, Department of Orthopedics, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
Chandrashekhar Patnala Professor, Department of Orthopedics, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India

DOI: https://doi.org/10.18502/jost.v8i4.10452

Keywords: Hip; Risk Factors; Comorbidity

Abstract

Background: Older adults who sustain hip fractures usually have multiple comorbidities that may impact their treatment and outcome. This study was conducted with the aim to analyze the risk factors that contribute to falls in elderly individuals and analyze the effect of comorbidities on the outcome and the treatment in elderly patients with hip fractures.

Methods: This cohort study was conducted on patients with hip fractures. We prospectively analyzed 140 individuals with geriatric hip fractures who had undergone surgery. The Charlson Comorbidity Index (CCI) and American Society of Anesthesiology (ASA) score of each geriatric hip fracture patient were calculated based on data obtained from medical records. Clinical assessment was assessed using a modified Harris Hip Score (HHS) during each visit.

Results: The mean age of patients was 72.21 ± 12.2 years. Their mean CCI and ASA was 1.02 ± 0.3 and 2.0 ± 0.53, respectively, and both were significantly associated with time-to-surgery (P < 0.001) and surgical treatment (P < 0.001). The length of hospital stay, duration of postoperative intensive care, and hospital expenses were associated with both CCI (P = 0.037) and ASA (P = 0.002). The greater the CCI and ASA scores were, the higher the chances of developing postoperative complications were (X2 = 15.724; P = 0.001). Delirium was the most common postoperative complication (15.7%), and pulmonary infection (11.4%) was the most fatal complication.

Conclusion: Patients with high CCI and ASA grading, and revision surgery were at high risk of postoperative complications, morbidity, and mortality. Orthogeriatric care offers the best chance for a successful outcome through efficient medical comanagement of these patients.