Risk factors for mortality and survival rates in elderly patients undergoing hemiarthroplasty for hip fracture

Acta Orthop Traumatol Turc. 2020 Mar;54(2):138-143. doi: 10.5152/j.aott.2020.02.298.


Objective: The aim of this study was to analyze the relationship between mortality and possible risk factors in elderly patients surgically treated with hemiarthroplasty for hip fracture and to determine mortality rates and yearly survival outcome in a selected cohort.

Methods: A total of 92 patients (51 men (55.4%) and 41 women (44.6%); mean age: 76.47 years) who underwent hemiarthroplasty for hip fracture were included into the study. The following data associated with risk factors were recorded for 92 patients: age, gender, pre-fracture activities of daily living (ADL), type of fracture, American Society of Anesthesiologists (ASA) score, therapeutic procedure, type of anesthesia, length of time after fracture until operation, postoperative mobility, and duration of hospitalization. A multivariate logistic regression test was used to evaluate the correlation between the risk factors and first- and second-year mortality rates. Third-year mortality rate after surgery was analyzed and compared with the general mortality rate in a similar population of the same age group living in the same city.

Results: The mortality rate was 18.5% (17 patients) after the first-year follow-up and 25% (23 patients) after the second year. The mortality risk after hip fracture was found to be 11.7 times greater than the similar age group population in the third year. In addition, there was a significant relationship between a low (dependent) preoperative ADL score, advanced age (>80 years), male gender, high ASA score and poor ability to walk (unable to walk), and first- and second-year mortalities (p<0.05). However, no significant relationship was found between fracture type, fracture side, anesthesia type, time from fracture to surgery, or duration of hospitalization and mortality (p>0.05).

Conclusion: Advanced age, male gender, a high ASA score, a dependent preoperative ADL score, and a postoperative inability to walk were determined to be the most important risk factors affecting mortality in elderly patients with hip fracture. The mortality risk was 11.7 times greater than that of a population with similar characteristics.

Level of evidence: Level IV, Therapeutic study.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Cohort Studies
  • Female
  • Hemiarthroplasty* / adverse effects
  • Hemiarthroplasty* / methods
  • Hemiarthroplasty* / statistics & numerical data
  • Hip Fractures* / mortality
  • Hip Fractures* / surgery
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / mortality
  • Postoperative Period
  • Risk Assessment / methods
  • Risk Factors
  • Survival Rate
  • Time-to-Treatment