In-hospital postoperative mortality of elderly patients with proximal femur fractures in a South African setting.

Abstract

Background: Epidemiological studies project that the incidence of proximal femur fractures in the elderly will triple within the next 30 years. These fractures are associated with significant morbidity and mortality despite ongoing efforts to improve outcomes. To improve outcomes, the American Academy of Orthopaedic Surgeons clinical practice guidelines recommend a multidisciplinary approach, a 48-hour window for surgical fixation, thromboprophylaxis as well as osteoporosis management. We aimed to determine the in-hospital mortality rate of surgically treated elderly patients with proximal femur fractures, as well as describe the series that died within the same admission and review the management of these fractures in a busy orthopaedic unit in rural KwaZulu Natal, South Africa. Methods: We performed a retrospective analysis of the data collected from the clinical records of all deceased elderly patients with proximal femur fractures who underwent surgery at our hospital from 01 January 2017 to 31 December 2021. The in-hospital mortality rate, time from injury to admission, admission to surgery and from surgery to death were assessed. Additionally, the workup for osteoporosis and clinical management to this subset of patients was evaluated. Results: Of 358 patients who underwent surgery during the study period, 24 died in the same admission resulting in an in-hospital mortality rate of 6,7%. 15 (62,5%) were females. All patients sustained fractures due to low-energy falls at home. Apart from one patient, with a pathological fracture secondary to known metastatic breast cancer, a cause of the fragility fracture was never actively sought. The median time from injury to admission was four days (IQR 2-19) and from admission to surgery was seven days (IQR 5-26). The median time from surgery to death was four days (IQR1-22). Conclusions: The in-hospital mortality rate of 6,7% is in keeping with global figures. Delays in both injury-to-admission and admission-to-surgery intervals may contribute to this mortality. The absence of a fragility fracture workup and subsequent medical treatment highlights important potential gaps in current practices. Urgent attention to reducing waiting times and implementing multidisciplinary approaches may be crucial in enhancing the overall management and outcomes of elderly patients with proximal femur fractures.