Comparative Outcomes of Hip Fractures in Centenarians Compared to Non-Centenarians

Background/Objectives: The number of hip fractures among centenarians is rising, yet their outcomes and the factors influencing mortality remain inadequately characterized. This study compared postoperative outcomes between centenarians and non-centenarians and examined perioperative factors associated with mortality. Methods: This retrospective cohort study included 31 centenarians (≥100 years) who underwent hip fracture surgery between October 2022 and March 2024 and 176 consecutive non-centenarians (65-99 years) admitted between October 2022 and April 2023. Associations between centenarian status, American Society of Anesthesiologists (ASA) score, comorbidity-only Charlson Comorbidity Index (CCI), surgical procedure, and time to surgery with 30-day and 12-month mortality were analyzed using logistic regression with clinically pre-selected covariates (Firth's method for 30-day mortality). Results: Centenarians exhibited higher ASA scores, while CCI values did not differ between groups. Centenarians experienced longer intensive care unit and hospital stays. The complication rate was numerically higher among centenarians (35.5% vs. 30.1%), although this difference was not statistically significant (p = 0.55). Thirty-day mortality was 29.0% for centenarians compared to 6.2% for non-centenarians, and 12-month mortality was 80.6% versus 30.1% (both p < 0.001). Centenarian status (30-day odds ratio [OR] 4.87, 95% confidence interval [CI] 1.73-13.60; 12-month OR 8.19, 95% CI 3.16-24.22) and higher ASA scores were associated with increased mortality, whereas CCI was not. Longer time to surgery was associated with higher 12-month mortality (OR 1.23 per 24 h, 95% CI 1.01-1.51). Conclusions: Centenarians demonstrated substantially higher short- and long-term mortality following hip fracture surgery compared to younger older adults. Extreme age and elevated ASA scores were associated with increased mortality, although unmeasured factors such as frailty may contribute to these associations. Hip fracture in centenarians should be considered a major life-limiting event that necessitates early goals-of-care discussions.