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Trauma: G. Holt, R. Smith, K. Duncan, D. F. Finlayson, and A. Gregori Early mortality after surgical fixation of hip fractures in the elderly: AN ANALYSIS OF DATA FROM THE SCOTTISH HIP FRACTURE AUDIT J Bone Joint Surg Br 2008; 90-B: 1357-1363 [Abstract] [Full text] [PDF]

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Early mortality after surgical fixation of hip fractures in the elderly

Dr Sunil Gurpur Kini, Dr Phani Madhuri .V   (16 October 2008)

Early mortality after surgical fixation of hip fractures in the elderly 16 October 2008
Dr Sunil Gurpur Kini, MBBS,M.S(Ortho),D.N.B(Ortho) Registrar Orthopaedics Guru Teg Bahadur Hospital , University College of Medical Sciences,Delhi,India, Dr Phani Madhuri .V Send letter to journal: Re: Early mortality after surgical fixation of hip fractures in the elderly drsunilkini{at}gmail.com Dr Sunil Gurpur Kini, et al.	Sir, We read this paper with interest. 1) The ASA scoring system as used in this study, though widely used, has its limitations in determining the timing of early versus delayed surgery as it does not reflect the severity of involved systems, especially ASA grades 2 and 3 with which most of the elderly surgical patients with hip fractures present. We are of the opinion that the decision for early operative intervention on an individual basis would be best represented by taking into consideration the physiological reserves and the comorbid conditions. The study by Dr JJ Roche et al has shown that age, male sex, and the presence of three or more comorbidities on admission all predicted a high risk of complications.1 2) The article has not shown an association with the time from admission to surgery and mortality at either 30 or 120 days. This would be a significant point of debate as most trials have shown at least an improvement in short-term mortality rates of operating early in the elderly population. The meta-analysis study of Toshiya Shiga et al showed that operative delay of more than 48 hours is associated with increased short-term and mid-term mortality in elderly patients with hip fracture but this did not correlate with the long-term mortality studies (at one year) because chronic comorbidities progress in older patients at high risk.2 At the same time it is imperative that in the elderly, the benefits of operating early must be weighed with the pre-operative comorbid conditions associated. S.G. Kini, MBBS, MS(Ortho),DNB(Ortho), Registrar Orthopaedics, V.P. Madhuri, Guru Teg Bahadur Hospital, University College of Medical Sciences, Delhi, India. 1. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 2005;331:1374. 2. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 2008;55:146-54.