Mortality in patients with hip fracture aged over 90 years: a report from a progressively aging island.

Introduction: In our aging society, hip fractures are common in elderly patients, especially those aged above 90 years. Improving mortality rates after this injury is an important part of medical management for the elderly. This study assessed mortality rates after hip fracture in patients aged ≥90 years and examined factors that contribute to mortality.

Method: Between April 2003 and March 2009, 186 patients aged ≥65 years were studied. Of these, 50 patients were aged ≥90 years. Walking ability before injury and at discharge, preoperative physical status, number of comorbidities, postoperative survival, sex, fracture type, and patients' residential status were investigated.

Results: One-year mortality was higher in patients aged ≥90 years (24%) than in younger patients (10%) (p=0.01). Moreover, older patients were less likely to retain walking ability at discharge, and poor postoperative ambulatory levels were associated with increased mortality. Preoperative physical status according to the grading system of the American Society of Anesthesiologists (ASA) did not differ between the two age groups. Poor ASA grade was associated with mortality in the entire population, but this association was not significant in the older group. Although older patients had a higher number of trochanteric fractures, fracture type and mortality did not significantly correlate with age.

Conclusion: Acceptable outcomes of hip fracture surgery can be achieved in very old patients. In addition, postoperative ambulatory level may be a predictor of mortality.