[Risk factors for mortality in nonagenarians with femoral neck fractures undergoing joint replacement]

To explore the risk factors for mortality in nonagenarians with femoral neck fractures and clarity the relationships between risk factors and postoperative mortality.

For this retrospective study, a total of 197 patients with consecutive isolated nonpathologic hip fractures undergoing hemiarthroplasty were recruited. There were 64 males and 133 females with an age range of 70 years or above. They were divided into three age groups: A, 70-79 years; B, 80-89 years; and C, ≥ 90 years. A retrospective chart review was conducted to compare these groups in terms of age, gender, nutritional status, blood albumin, total lymphocyte count, hemoglobin levels at admission, comorbidities, American Society of Anesthesiologists (ASA) rating of operative risk and time period between injury and surgery.

Among them, 14 patients died within 1 year. There was one in-hospital death and 13 patients died during follow-ups. The mortality rates of groups A, B and C were (n = 3, 3.9%), (n = 5, 7.2%) and (n = 6, 24.0%). The ASA scores were III (n = 9) and IV (n = 4). And 13 patients had a preoperative blood albumin level < 35 g/L while 11 patients showed a preoperative lymphocyte count level < 1 500 cells/ml. The mortality rates were similar in groups A and B but were significantly lower than that of group C.

The nonagenarians have a significantly higher mortality. And lower lymphocyte count, nonagenarian, > 2 comorbidities, high ASA score, low blood albumin level and low hemoglobin levels at admission are significant factors for assessing 1-year mortality in elders with femoral neck fractures.