Effects of predictors of mortality at the stage of providing trauma care for fractures of the proximal femur in people 50 years of age and older

BACKGROUND: In Russia, according to official statistics, a high level of conservative treatment of fractures of the proximal femur remains, especially in older age groups. In this regard, assessing the effects of predictors of mortality at the stage of providing trauma care to such patients remains relevant. Тhere is ongoing debate regarding the timing of the effect of surgical treatment on mortality associated with the fracture event itself.

AIM: To assess the effect on mortality of hip fractures in people 50 years of age and older of the type of treatment (operative or conservative) and the duration of the preoperative period.

MATERIALS AND METHODS: A cross-sectional retrospective study with a prospective component was conducted on fractures of the proximal femur that occurred from January 1, 2019 to December 31, 2019 in people over 50 years of age living in the urban district of Armavir. The Kaplan-Meier method was used to analyze mortality.

RESULTS: Significantly longer survival after surgical treatment compared with conservative treatment was due to lower patient mortality in the interval up to 240 days (Breslow criterion (Generalized Wilcoxon, p<0.007) from the moment of injury Mortality by this period was, respectively, 11.7% versus 32.7%, the average mortality per day per 1000 patients is 0.489 among those operated on and 1.37 among those not operated on. In groups stratified by age and Charlson index, significant differences were noted only for persons 80 years of age and older. A delay in surgical intervention of more than 72 hours significantly increased mortality (Pearson chi-square test, log-rank test, p=0.012.

CONCLUSION: Surgical treatment performed within 72 hours of the hip fracture reduces or minimizes the risk of death associated directly with the fracture event itself, including in persons over 80 years of age. The effect of surgical intervention on mortality is maximally manifested in the time interval of 6-8 months after the fracture.

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