In-hospital mortality does not increase in patients aged over 85 years after hip fracture surgery. A retrospective observational study in a Japanese tertiary hospital

Hip fracture is a common and serious orthopedic injury among the geriatric population, necessitating surgical treatment. We tested whether age is a significant risk factor for in-hospital mortality after surgery in this retrospective cohort study and, further, analyzed causes and pattern of death in those patients. We queried the electronic hospital records of in-patients aged over 75 years who had undergone hip fracture surgery from the start of 2010 to the end of August 2016 in our hospital, a tertiary hospital on the main island of Japan. The extracted data included patient ID, age, gender, location of fracture, ASA-PS scores, types of anesthesia, durations of anesthesia and surgery, days of hospital stay after surgery, and outcomes at hospital discharge including in-hospital death. The extracted data were divided into two groups based on the patient’s age at the time of surgery: the aged group (age of < 85) and the advanced age group (age of ≥ 85 years), and we compared patient characteristics and management variables and discharge disposition between the two groups. Eight hundred four patient records were extracted (360 in the aged and 444 in the advanced age groups). Although a smaller proportion of patients in the advanced age group could be discharged home, all-cause in-hospital mortality was also similar between the two groups (1.9 and 1.6%, aged and advanced age groups, respectively). Six patients died from advanced cancer, and five patients died of pneumonia resulting from aspiration. The results of this study suggest that age is not a clinically significant risk factor for in-hospital mortality. The possibility decreasing in-hospital mortality exists in identifying patients at risk of aspiration and preventing it.