Factors associated with mortality in older patients sustaining pelvic or acetabular fractures.
Arch Orthop Trauma Surg
Springer Science and Business Media LLC
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Harrison, A., Ordas-Bayon, A., Chimutengwende-Gordon, M., Fortune, M., Chou, D., Hull, P., Carrothers, A., & et al. (2022). Factors associated with mortality in older patients sustaining pelvic or acetabular fractures.. Arch Orthop Trauma Surg, 142 (7), 1547-1556. https://doi.org/10.1007/s00402-021-03873-5
INTRODUCTION: This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures. MATERIALS AND METHODS: A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72 h and after 72 h. Kaplan-Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models. RESULTS: Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery (fracture fixation within or greater than 72 h), there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72 h were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index (CCI) and pre-op mobility status were associated with statistically significant differences in overall mortality. The same factors were associated with a significantly increased hazard of death in the multivariate Cox proportional hazards model. Patient gender, mechanism of injury, Injury Severity Score (ISS) > 15 and head injury were not significant predictors of mortality. CONCLUSION: Surgical intervention within 72 h of injury did not result in decreased mortality in older patients with PA fractures. The 1-year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach between orthogeriatric and expert PA surgeons for these patients.
Trauma Surgery, Acetabular fracture, Pelvic fracture, Geriatric trauma, Mortality
External DOI: https://doi.org/10.1007/s00402-021-03873-5
This record's URL: https://www.repository.cam.ac.uk/handle/1810/338477