Efficacy comparison of operation and non-operation for nonagenarians with hip fracture / 中华创伤杂志

ABSTRACT

Objective To compare the efficacy of operation and non-operation treatment for nonagenarians with hip fracture.Methods A retrospective case control study was conducted to analyze the data of 183 patients over 90 years old with hip fracture admitted to the seventh medical center of Chinese PLA General Hospital from January 2012 to December 2016.There were 87 males and 96 females,aged 90-104 years [(93.0 ± 2.9) years].Among the patients,101 were treated surgically (operation group) and 82 were treated nonoperatively (non-operation group).The hospitalization time,incidence of complications,mortality and survival curve at 30 days and 1 year after injury were compared between the two groups.Multivariate logistic regression analysis was used to calculate the risk of death in patients who did not undergo operation at 30 days and i year after injury.Functional recovery was assessed by comparing the walking ability and activities of daily living (ADL) before injury and 1 year after injury.Results The hospitalization time was (16.6 ± 13.7)days for operation group and (21.7 ± 16.0) days for the non-operation group (P ＜ 0.05).The operation group had a complication incidence of 40.6％ (41/101),and the non-operation group 58.5％ (48/82).Nine patients (8.9％) in the operation group and nine patients (11.0％) in the non-operation group died 30 days after injury (P ＜0.05).A total of 27 deaths (26.7％) in operation group and 38 deaths (46.3％) in the non-operation group were recorded within 1 year after injury (P ＜ 0.05).The non-operation group had a much higher death risk than the operation group (P ＜ 0.05).Multivariate Logistic regression analysis showed that nonoperation treatment was significantly associated with death risk 1-year after injury (OR =2.672,95％ CI 1.262-5.655,P ＜ 0.05),but not with the death risk 30-day mortality (OR =1.144,95％ CI 0.678-3.461,P ＞ 0.05).In the operation group,45 patients (44.6％) could walk independently before injury and 56 patients (55.4％) could walk partially independently before injury;in the non-operation group,31 patients (37.8％) could walk independently before injury and 51 patients (62.2％) could walk partially independently before injury,with no significant difference between the two groups (P ＞ 0.05).The average ADL score before injury in operation group was (61.4 ± 8.2)points,while that in nonoperation group was (60.3 ± 9.2) points (P ＞ 0.05).At 1 year after operation,20 patients (19.8％) in the operation group could walk independently,43 patients (42.6％) could walk partially independently,and 11 patients (10.9％) needed to stay in bed;only one patient (1.2％) in the non-operation group could walk independently,32 patients (39.0％) could walk partially independently,and 11 patients (13.4％) needed to stay in bed,with significant difference between the two groups (P ＜ 0.05).The average ADL score was (51.4 ± 10.9) points in the operation group and (43.2 ± 7.2) points in the nonoperation group 1 year after operation (P ＜ 0.05).Conclusions For the nonagenarians patients with hip fracture,operation treatment is superior to non-operation treatment in terms of hospitalization time,complication incidence,1-year mortality and functional recovery.Non-operation treatment is the independent risk factor for death risk 1 year after injury.