• Hip fracture
• Mortality
• Nationwide database
• Osteoporosis
• Super-elderly

• Humans
• Hip Fractures/surgery
• Hip Fractures/mortality
• Male
• Female
• Aged, 80 and over
• Hospital Mortality
• Postoperative Complications/mortality
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Aged
• Japan/epidemiology
• Databases, Factual
• Retrospective Studies
• Pneumonia/mortality
• Pneumonia/etiology
• Risk Factors

• Hip fracture
• Nonagenarian
• Surgery

• Humans
• Aged
• Retrospective Studies
• Proximal Femoral Fractures
• Intensive Care Units
• Hospitalization
• Critical Care

• Conservative
• Fragility
• Non-hip
• Nonagenarian
• Orthogeriatrics
• Survival

• Aged ≥90 years
• Risk factor
• Serious postoperative outcome
• Surgery

The outcomes of nonagenarian patients undergoing orthopaedic surgery are not well understood. We investigated the 30-day mortality after surgical treatment of unilateral hip fracture. The relationship between postoperative complications and mortality was evaluated.

We performed a single-centre retrospective cohort study of nonagenarian patients undergoing hip fracture surgery over a 6-year period. Postoperative complications were graded according to the Clavien–Dindo classification. Correlation analyses were performed to evaluate the relationship between mortality and pre-specified mortality risk predictors. Survival analyses were assessed using Cox proportional hazards regression modelling.

The study included 537 patients. The 30-day mortality rate was 7.4%. The mortality rate over a median follow-up period of 30 months was 18.2%. Postoperative complications were observed in 459 (85.5%) patients. Both the number and severity of complications were related to mortality (p < 0.001). Compared to patients who survived, deceased patients were more frail (p = 0.034), were at higher ASA risk (p = 0.010) and were more likely to have preoperative congestive heart failure (p < 0.001). The adjusted hazard ratio for mortality according to the number of complications was 1.3 (95% CI 1.1, 1.5; p = 0.003). Up to 21 days from admission, any increase in complication severity was associated significantly greater mortality [adjusted hazard ratio: 3.0 (95% CI 2.4, 3.6; p < 0.001)].

In a nonagenarian cohort of patients undergoing hip fracture surgery, 30-day mortality was 7.4%, but 30-month mortality rates approached one in five patients. Postoperative complications were independently associated with a higher mortality, particularly when occurring early.

The online version contains supplementary material available at 10.1186/s13018-021-02807-6.

• Anaesthesia
• Complication
• Fracture
• Nonagenarian
• Surgery

• Complications
• Femoral fracture
• Hip fracture
• Mortality
• Neck of femur
• Orthogeriatric
• Surgical delay
• Time to surgery

• Arthroplasty, Replacement, Hip
• Fracture Fixation, Internal/methods
• Hip Fractures/mortality
• Hip Fractures/surgery
• Hospital Mortality
• Humans
• Time-to-Treatment

• MR/L01226X/1 Medical Research Council

• hip fracture
• nonagenarians
• postoperative complications
• short-term mortality
• treatable risk factors

The aging of the Chinese population is expected to lead to an increase in nonagenarians and centenarians. The mortality rate in nonagenarian hip fracture patients is equivalent to the mortality rate in the average population at 5 years after injury. It is imperative to evaluate 5-year mortality in this small but very challenging subgroup of patients to optimize patient management. The primary purpose of the current retrospective study was to compare five-year survival in patients aged over 90 years who received arthroplasty or nonoperative treatment for femoral neck fracture during a 16-year period.

From January 1998 to December 2014, all consecutive nonagenarian and centenarian patients with femoral neck fracture admitted to our hospital were included in the evaluation. The primary outcome was defined as thirty-day, 1-year, 3-year, and 5-year mortality after injury. Survival analysis was performed with the Kaplan-Meier method. Using the log-rank test, stratified analyses were performed to compare differences in the overall cumulative mortality and mortality at three time points (1 year, 3 years, and 5 years) after injury and differences in survival distributions.

Over the 16-year study period, the arthroplasty group and the nonoperative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group was significantly higher than that of the nonoperative treatment group (p = 0.002). The survival time of the arthroplasty group was significantly higher than that of the nonoperative treatment group (median (P₇₅-P₂₅) = 53 (59) versus median (P₇₅-P₂₅) = 22 (52), p = 0.001). The mortality differences, except for 30-day mortality, at five time points (1, 2, 3, 4, and 5 years) between the nonoperative group and arthroplasty group were significant. The stratified analyses of overall cumulative mortality and mortality at three time points (1, 3, and 5 years) after injury demonstrated that the nonoperative treatment group had significantly higher cumulative mortality than the arthroplasty group.

Our study demonstrates that arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. It can be expected that nearly half of patients will survive more than 5 years after surgery.

• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/adverse effects
• Databases, Factual
• Female
• Fracture Fixation, Intramedullary/adverse effects
• Hemiarthroplasty/adverse effects
• Hip Fractures/mortality
• Hip Fractures/surgery
• Humans
• Hypoalbuminemia/blood
• Hypoalbuminemia/epidemiology
• Intubation, Intratracheal/statistics & numerical data
• Length of Stay/statistics & numerical data
• Male
• Open Fracture Reduction/adverse effects
• Orthopedic Procedures/adverse effects
• Patient Readmission/statistics & numerical data
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Predictive Value of Tests
• Reoperation/statistics & numerical data
• Retrospective Studies
• Risk Factors
• Serum Albumin/metabolism
• Time Factors
• Treatment Outcome
• United States/epidemiology

Objectives: To investigate the details of patients’ status on admission and at discharge at our hospital, to compare the ambulatory group and non-ambulatory group at discharge, and to assess the factors associated with ambulatory ability at discharge in patients aged ≥ 90 years with proximal femoral fractures (PFFs).

Patients/Materials and Methods: Twenty patients admitted to our hospital for rehabilitation after surgery for a PFF were evaluated retrospectively. The rate of regaining ambulatory ability, presence of dementia, body mass index, serum albumin level, hemoglobin level, lymphocyte count, and functional independence measure (FIM) were assessed on admission and at discharge. Relationships between patients’ ambulatory ability and ambulatory parameters were compared between the ambulatory and non-ambulatory groups.

Results: The rate of regaining ambulatory ability was 55% at discharge. The serum albumin level at discharge was significantly higher in the ambulatory group than that in the non-ambulatory group. More patients had dementia on admission in the non-ambulatory group than in the ambulatory group. On admission, scores for the cognitive items of the FIM (“expression” and “memory”) were significantly higher in the ambulatory group than those in the non-ambulatory group.

Conclusions: The rate of ambulatory ability at discharge was 55% in those with a PFF, who were aged ≥ 90 years. The presence of dementia on admission and serum albumin level at discharge were factors related to ambulatory ability. It is very important to use a general rehabilitation protocol that takes cognitive function and nourishment into account, in addition to the physical aspect.

• ambulation
• elderly patients
• proximal femoral fracture

• Femur neck fractures
• Hip fractures
• Nonagenarians
• Trochanteric fractures

The development of end stage renal failure can be seen as a catastrophic health event and patients with this condition are considered at the highest risk of cardiovascular disease among any other patient groups and risk categories. Although kidney transplantation was hailed as an optimal solution to such devastating disease, many issues related to immune-suppressive drugs soon emerged and it became evident that cardiovascular disease would remain a vexing problem. Progression of chronic kidney disease is accompanied by profound alterations of mineral and bone metabolism that are believed to have an impact on the cardiovascular health of patients with advanced degrees of renal failure. Cardiovascular risk factors remain highly prevalent after kidney transplantation, some immune-suppression drugs worsen the risk profile of graft recipients and the alterations of mineral and bone metabolism seen in end stage renal failure are not completely resolved. Whether this complex situation promotes progression of vascular calcification, a hall-mark of advanced chronic kidney disease, and whether vascular calcifications contribute to the poor cardiovascular outcome of post-transplant patients is reviewed in this article.

• morbidity
• Chronic kidney disease-mineral bone disorder
• cardiovascular disease
• chronic kidney disease
• Mortality
• Bone fractures