Comorbid Profile Rather than Age Determines Hip Fracture Mortality in a Nonagenarian Population

HSS Journal Online First Article

Adam Graver, MD
North Shore LIJ, New Hyde Park, NY

Sara Merwin, MPH
Department of Orthopaedic Surgery, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, NY

Lewis Collins, OPA
University Orthopaedic Associates, Great Neck, NY

Nina Kohn, MBA, MA
Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, NY

Ariel Goldman, MD
Department of Orthopaedic Surgery, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, NY


In light of poor outcomes with nonoperative management of hip fractures, orthopedic surgeons are faced with difficult decisions about which patients are too ill or too old for surgical treatment.

This study sought to investigate if patients over 90 years had different preoperative laboratory, clinical, and injury characteristics than younger patients with the same injury. We compared our cohort with previously published data. We wished to identify if there were pre-injury risk factors associated with 30-day mortality, which could be modified to enhance postoperative outcomes.

This is a retrospective review of 198 operatively managed hip fractures in patients 75 years or older. We collected data on demographics, select preoperative laboratory values, injury type, comorbidities, and 30-day mortality.

Eleven (5.6%) of the cohort died within 30 days of surgery, 6.3% in the younger group, and 3.7% in the older group; the difference was not statistically significant. For baseline characteristics, there was no difference between the age groups for pre-injury comorbidities, hemoglobin, serum albumin, BUN, prevalence of UTI, or fracture type. A total of 67 (35.8%) patients had evidence of UTI on admission.

These findings reveal that in our dichotomized cohort, pre-injury characteristics were similar and age alone was not an independent predictor of mortality. These data may inform decision-making for orthopedic surgeons and the medical providers who consult to optimize these patients for surgery. We identified high rates of UTI in both age groups, a potentially remediable factor to optimize outcomes in hip fracture surgery in elderly patients.

This Online First article was published online on SpringerLink in July 2015.
View the full HSS Journal article at

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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