title: Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures.
abstract: BACKGROUND
  The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality.
  
  
  METHODS
  Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery.
  
  
  RESULTS
  Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036).
  
  
  CONCLUSIONS
  Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.
authors.affiliation: Department of Orthopedics, University of Toledo Medical Center, Toledo, OH, USA.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Fansa
authors.affiliation: College of Medicine, University of Toledo Medical Center, Toledo, OH, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Huff
authors.affiliation: Department of Orthopedics, University of Toledo Medical Center, Toledo, OH, USA.
authors.forename: Nabil
authors.initials: N
authors.lastname: Ebraheim
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D003704:Dementia; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies
keywords: Femur neck fractures; Hip fractures; Nonagenarians; Trochanteric fractures