Neck of Femur Fractures in Patient’s Aged More Than 85 Years—are They a Unique Subset?

Abstract

Background. The UK population is ageing with the largest increase expected to occur in people aged more than 85 years (85+). We have examined the hypothesis that neck of femur (NOF) fractures in the 85+ group exhibit demonstrable key outcome measurement differences after surgery when compared to a standard NOF population. Patients and Methods. A prospective observational cohort study of the demographics, clinical features, and key clinical outcome measurements for 2 groups of patients (65-84 and 85+ years of age at presentation) was performed in a single trauma unit over a 3-year period. Results. A total of 699 patients with a median age of 78 in the 65 to 84 cohort were compared with 523 patients with a median age of 88 in the 85+ cohort. Despite a dedicated orthogeriatric service and no difference in time to surgery between the 2 groups, the 30-day and 1-year mortality rates were significantly higher in the 85+ cohort at 10% and 30%, respectively, compared with 5% and 19% in the younger patient group. In our 85+ group, 34% had evidence of significant measured cognitive impairment compared to only 19% in the 65 to 84 group ( P < .001). The length of hospital inpatient stay was also longer in the 85+ cohort with a median of 20 days compared to 16 days in the younger cohort ( P = .001). In the 85+ cohort, 60% of patients were discharged back to their usual (preinjury) place of residence compared to 72% in the 65 to 84 cohort ( P = .001). Conclusions. Patients in 85+ group presenting with an NOF fracture represent a unique high-risk patient group. Despite adherence to published key principles of care, this group is at higher risk and as such merits focused clinical attention, with adequate patient and family member counseling with regard to prognosis and overall expectation.