Association Between Non-Operative versus Operative Management and Mortality in Elderly Patients with Hip Fracture: A...

To compare outcomes between non-operative and operative management of hip fractures in elderly patients.

In this single-center retrospective cohort study (January 2018-December 2022), we enrolled 298 elderly patients with hip fractures after excluding 704 from an initial 1,002 consecutive cases. This study excluded patients with old fractures, other types of fractures, lack of data on injury reason, and absence of follow-up data. Multivariable logistic regression was used to explore the association between different treatment and mortality, adjusting for age, gender, injury reason, fracture type, hypertension, and diabetes. Subgroup analyses were employed to assess the association between the different treatments and mortality.

Among the 298 elderly patients with hip fractures, 59 were managed non-operatively and 239 underwent surgery. The overall 1-year mortality rate was 14.43% (43/298). Mortality was 25.42% (15/59) in the non-operative group and 11.72% (28/239) in the operative group. After adjustment, surgical management reduced mortality risk by 61% (OR =0.39, 95% CI:0.19-0.82, P = 0.013). Subgroup analysis demonstrated significant benefit in patients < 80 years (87% risk reduction; OR = 0.13, 95% CI: 0.04-042), whereas no significant association was observed in ≥ 80-year-olds (OR = 0.85, 95% CI:0.32-2.80, P for interaction = 0.023).

Our analysis indicates an association between operative management and reduced mortality risk in elderly hip fracture patients. This benefit was observed to be more marked in individuals aged under 80 years. While consistent with existing observational studies, these findings merit confirmation through randmised controlled trials, particularly to determine optimal management strategies for the oldest old (≥80 years).