OTA 2012 Posters

Scientific Poster #26 Hip/Femur OTA-2012

Mortality of Femoral Neck Fractures in the Elderly Based on Charlson Comorbidity Index and Treatment Modality

Adam Shar, MD; Timmothy Randell, MD; Christopher D. Chaput, MD;
Daniel C. Jupiter, MD; Kindyle L. Brennan, PhD; Zachary T. Hubert, BS;
Robert A. Probe, MD; Michael L. Brennan, MD;Scott and White Memorial Hospital, Temple, Texas, USA

Purpose: Femoral neck fractures constitute significant mortality in the elderly population. No study to date has assessed mortality in relation to comorbidity status and treatment modality in this population. The purpose of the study is to determine if the Charlson Comorbidity Index (CCI) has prognostic value in assessing mortality in patients with femoral neck fracture, with and without taking surgery type into account, and to determine a cutoff for CCI above which the hazard ratio for death increases significantly.

Methods: This retrospective cohort study included patients aged ≥60 years with femoral neck fractures from low-energy trauma at a Level I trauma center between 1998 and 2009, netting 1525 cases in 1440 patients. Data collected include demographics, CCI, surgery type (closed reduction and percutaneous pinning [CRPP], hemiarthroplasty [HA], total hip arthroplasty [THA]), and death date. Kaplan-Meier estimates were used to determine the relationship between CCI and mortality rates, and to identify a CCI at which the hazard ratio for death changed significantly. In a post hoc subanalysis, patients were categorized into 3 groups based on severity of CCI (low, 2-4; medium, 5-6; high, ≥7). In each group, mortality at 1 month, 6 months, 1 year, and 2 years is calculated, with and without taking surgery type into account. Cox proportional hazards regression and χ2 tests were used where appropriate.

Results: Of 1,525 fractures, 745 underwent CRPP, 749 underwent HA, and only 40 had THA. CCI was a significant factor in mortality (P <0.001), and increase of CCI by 1 increased the hazard ratio for death by 1.35 (95% confidence interval [CI] 1.30-1.40). At CCI ≥11, the hazard ratio for death increased 5-fold; however, only 6 cases (0.4%) met this criterion. In an analysis based on 3 groups of CCI, 1-month mortality throughout the entire study population in order of low, medium, and high CCI groups were 2%, 7%, and 16%, respectively (P <0.001); at 6 months; they were 7%, 19%, and 34% (P <0.001); at 1 year; they were 10%, 24%, and 46% (P <0.01); at 2 years, they were 17%, 35%, and 58% (P <0.001). A subset analysis that controlled for surgery type revealed a similar increase in mortality with increasing CCI. Most notably, mortality is greatest in the high CCI group at 2 years (60% for CRPP and 58% for HA).

Conclusion: Increasing CCI was associated with increased mortality after surgical intervention for femoral neck fractures. This association remained significant even after controlling for surgery type. Assessment for the THA group is limited secondary to low power.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.