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Age-stratified mortality after hip fracture surgery: A retrospective cohort study comparing hemiarthroplasty and
Murat Gök1, Tuna Koçoğlu2, Fatih Işık1
1Department of Orthopedics and Traumatology, University of Health Sciences, Balıkesir Atatürk City Hospital, Balıkesir-Türkiye.
Background:
Hip fractures are a major public health problem associated with substantial mortality and morbidity, particularly among older adults. More than 90% of hip fractures occur in individuals aged 50 years and older, and the incidence increases with age because of osteoporosis and declining bone quality. This study aimed to examine the association between surgical treatment method and short- and long-term mortality after hip fracture, with an emphasis on age-stratified outcomes.
Methods:
This retrospective cohort study included patients aged 65 years and older who underwent surgery for hip fracture at a tertiary care center. Age and time to surgery were analyzed as continuous variables, whereas sex, surgical method, comorbidities, and follow-up status were analyzed as categorical variables. Baseline characteristics were compared between surgical treatment groups using the independent samples t-test or Mann-Whitney U test for continuous variables and the chi-square test for categorical variables, as appropriate. Cumulative mortality at predefined time points was assessed descriptively, and overall survival was evaluated using Kaplan-Meier survival analysis with comparisons performed using the log-rank test.
Results:
A total of 885 patients met the inclusion criteria; 509 patients (57.5%) underwent hemiarthroplasty and 376 patients (42.5%) underwent osteosynthesis. There was no significant difference in one-year cumulative mortality between the groups (p=0.984). At five years, cumulative mortality was higher in the hemiarthroplasty group than in the osteosynthesis group (68.1% vs. 58.5%, p=0.003). Among patients with a Charlson Comorbidity Index ≤5, five-year cumulative mortality was also higher following hemiarthroplasty (61.1% vs. 50.1%, p=0.010). Kaplan-Meier analysis demonstrated significant differences in overall survival between the surgical treatment groups.
Conclusion:
Higher long-term mortality following hemiarthroplasty was more evident among younger elderly patients and those with a lower comorbidity burden, whereas differences were less pronounced in older patients or those with greater comorbidity.