title: Comorbid Profile Rather than Age Determines Hip Fracture Mortality in a Nonagenarian Population.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040 USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Graver
authors.affiliation: Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040 USA ; Hofstra North Shore-LIJ School of Medicine, 500 Hofstra University, Hempstead, NY 11549 USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Merwin
authors.affiliation: North Shore-LIJ Medical Group, University Orthopaedic Associates, 611 Northern Blvd Suite 200, Great Neck, NY 11021 USA.
authors.forename: Lewis
authors.initials: L
authors.lastname: Collins
authors.affiliation: Biostatistics Unit, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030 USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Kohn
authors.affiliation: Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040 USA ; Hofstra North Shore-LIJ School of Medicine, 500 Hofstra University, Hempstead, NY 11549 USA ; North Shore-LIJ Medical Group, University Orthopaedic Associates, 611 Northern Blvd Suite 200, Great Neck, NY 11021 USA ; North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030 USA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Goldman
keywords: comorbidity; fragility fractures; geriatrics; mortality; orthopedic; postoperative