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The cost and mortality of hip fractures in centenarians
J Moore1,2, O Carmody3, B Carey3
1Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland. jossymoore@hotmail.com.
Insights
Hip fractures in centenarians are costly but operative management is suggested. This study found a 71% 1-year mortality rate, comparable to the expected lifespan for this age group.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Health Economics
Background:
- Centenarians represent a rapidly growing demographic in Ireland.
- Hip fractures in the elderly are linked to high morbidity, mortality, and healthcare costs.
- Limited data exists on hip fractures specifically in centenarians.
Purpose of the Study:
- To examine the experience of hip fractures in centenarians.
- To determine the treatment costs associated with these fractures.
- To assess the social and economic impact on the healthcare system.
Main Methods:
- Retrospective data review at a major trauma center (2010-2016).
- Identified nine proximal femoral fractures in patients over 100 years old.
- Calculated inpatient costs using length of stay, theatre time, and implant costs.
Main Results:
- Nine centenarians underwent operative management for hip fractures.
- Average inpatient cost was €14,898 per patient.
- Inpatient, 30-day, and 1-year mortality rates were 22%, 22%, and 71%, respectively.
Conclusions:
- The 1-year mortality rate (71%) is comparable to the expected mortality for individuals aged 100+.
- Operative management should be considered for the extreme elderly with hip fractures.
- This approach may mitigate some of the social and economic burdens.
Background:
Centenarians are the fastest rising age group in Ireland. Hip fractures most commonly affect older adults and are associated with significant morbidity and mortality, as well as the financial cost of healthcare resources. Despite this, very little is known regarding hip fractures in centenarians. The aim of this study was to investigate our experience with hip fractures in this group and to record the cost of treating these fractures to identify both the social and economic impact these injuries impose on the health system.
Methods:
The study was a retrospective data review at a major trauma centre. Nine proximal femoral fractures from June 2010-2016 were identified through a stepwise analysis of theatre data and patient notes. Time of death was recorded directly from patient records or by contacting the patient's general practitioner. With the assistance of the hospital finance department, individual inpatient costs were calculated using length of stay, theatre time and implant costs.
Results:
Over the 7-year period we examined nine patients over 100 years of age were managed operatively for hip fractures with an average inpatient cost of €14,898. The mean age at the time of fracture was 101 years and 7 months. Eight of the patients were female and there was one male. Our inpatient, 30-day and 1-year mortality rate were 22, 22, and 71%.
Conclusions:
The 1-year mortality rate of any person aged 100 years or older is thought to be 67% for men and 59% for women. This suggests that the 1-year mortality rate of 71% in this current study is only slightly worse than the usual life expectancy of a person older than 100 years of age. Our data suggest that the extreme elderly should be offered operative management.
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