title: Outcome after osteosynthesis of hip fractures in nonagenarians.
abstract: BACKGROUND
  Hip fractures in the elderly population are associated with high morbidity and mortality. However, there is still a lack of information on mortality and loss of independence in extremely elderly people with a hip fracture.
  
  
  OBJECTIVE
  To study functional outcomes and mortality after osteosynthesis of hip fractures in very old patients in our clinic.
  
  
  METHODS
  Hospital charts of all patients over 90 years old who were operated for a hip fracture between January 2007 and December 2011 were reviewed. Outcome measures were mortality, preoperative and postoperative mobility, and loss of independence.
  
  
  RESULTS
  A total of 149 patients were included; 132 (89%) women, median age 93.5±2.45 years. Thirty-six (24%) patients were classified as American Society of Anesthesiologists (ASA) grade 2, 104 (70%) as ASA grade 3, and nine (6%) as ASA grade 4. The Charlson comorbidity index (CCI) score was 2 or less in 115 (77%) patients and 34 (23%) patients scored 3 or more points. Short-term survival was 91% and 77% at 30 days and 3 months, respectively. Long-term survival was 64%, 42%, and 18% at 1, 3, and 5 years after surgery, respectively. Survival was significantly better in patients with lower ASA scores (P=0.005). No significant difference in survival was measured between patients according to CCI score (P=0.13). Fifty-one percent of patients had to be accommodated in an institution with more care following treatment, and 57% were less mobile after osteosynthesis of a hip fracture.
  
  
  CONCLUSIONS
  Our study shows that short-term mortality rates in very elderly patients with a hip fracture are high and there is no clear predictive value for mortality. ASA classification is the best predictive value for overall mortality. A large proportion of these patients lost their independence after osteosynthesis of a hip fracture.
authors.affiliation: Department of Surgery, Breda, The Netherlands.
authors.forename: Kevin
authors.initials: K
authors.lastname: de Leur
authors.affiliation: Department of Surgery, Breda, The Netherlands.
authors.forename: Jos P A M
authors.initials: JP
authors.lastname: Vroemen
authors.affiliation: Department of Surgery, Breda, The Netherlands.
authors.forename: Dagmar I
authors.initials: DI
authors.lastname: Vos
authors.affiliation: Orthopedics, Amphia Hospital, Breda, The Netherlands.
authors.forename: Leon
authors.initials: L
authors.lastname: Elmans
authors.affiliation: Department of Surgery, Breda, The Netherlands.
authors.forename: Lijckle
authors.initials: L
authors.lastname: van der Laan
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal / Q000401:mortality; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: hip fracture; loss of independence; mortality; osteosynthesis; very elderly people