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      Predictors of in-hospital mortality in older patients undergoing distal femur fracture surgery: A case-control study

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          Abstract

          Introduction: Geriatric fractures including distal femur and hip fractures are associated with high mortality rates. Currently, prognostic factors for in-hospital postoperative mortality are not identified. We aimed to evaluate overall in-hospital mortality and related potential risk factors in elderly patients who underwent distal femur fracture surgery. Materials and methods: A retrospective cohort study of patients older than 60 years, who underwent distal femur fracture surgery between January 01, 2003, and December 31, 2021, was conducted. A case-control study was conducted to compare two age-matched groups of elderly patients of equivalent ages at a 1:4 ratio. The in-hospital mortality rate was calculated and potential confounders were compared between groups. Results: A total of 170 patients were enrolled; five died during hospital stay after undergoing surgery, yielding a 2.94% in-hospital mortality rate. Twenty patients who did not die were included in the control group. Patients’ demographics were similar. The case-control comparison showed that the time from injury to surgery, preoperative hemoglobin level, estimated glomerular filtration rate (eGFR), and white blood cell count were significant factors correlated with in-hospital mortality. Discussion: The overall in-hospital mortality rate was 2.94%. Significant risk factors for in-hospital mortality included a longer time from injury to surgery, lower preoperative hemoglobin level and eGFR, and higher preoperative white blood cell count. In conclusion, preoperative comprehensive geriatric assessment, including cognitive, nutritional, and frailty status, should also be considered in the elderly fracture care model.

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          Most cited references27

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          Epidemiology of adult fractures: A review.

          The epidemiology of adult fractures is changing quickly. An analysis of 5953 fractures reviewed in a single orthopaedic trauma unit in 2000 showed that there are eight different fracture distribution curves into which all fractures can be placed. Only two fracture curves involve predominantly young patients; the other six show an increased incidence of fractures in older patients. It is popularly assumed that osteoporotic fractures are mainly seen in the thoracolumbar spine, proximal femur, proximal humerus and distal radius, but analysis of the data indicates that 14 different fractures should now be considered to be potentially osteoporotic. About 30% of fractures in men, 66% of fractures in women and 70% of inpatient fractures are potentially osteoporotic.
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            Mortality after distal femur fractures in elderly patients.

            Hip fractures in the elderly are associated with high 1-year mortality rates, but whether patients with other lower extremity fractures are exposed to a similar mortality risk is not clear.
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              The epidemiology of fractures of the distal femur.

              Between 1980 and 1989, reports on 2,165 fractures of the distal part of the femur (1,051 women and 1,114 men) were collected by AO Documentation and are analyzed in the present paper. The number of fractures showed a bimodal pattern with a marked variation in the number of fractures in relation to gender and age. A larger prevalence of fractures was observed either in young men (about 20 years old, traffic or sport) and in old women (about 70, fall at home, osteoporosis).
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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2023
                07 December 2023
                : 9
                : 36
                Affiliations
                [1 ] Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
                [2 ] Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University Kaohsiung Taiwan
                [3 ] Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University Tainan Taiwan
                [4 ] Department of Orthopaedic Surgery, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University Yunlin Taiwan
                Author notes
                [* ]Corresponding author: yayahong@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-4061-7107
                http://orcid.org/0000-0001-9408-0651
                http://orcid.org/0000-0002-7576-2486
                http://orcid.org/0000-0003-3231-1789
                Article
                sicotj230087 10.1051/sicotj/2023035
                10.1051/sicotj/2023035
                10702471
                38059859
                d99af840-4683-43a4-a139-bf2e8ca36102
                © The Authors, published by EDP Sciences, 2023

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 October 2023
                : 19 November 2023
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 27, Pages: 6
                Funding
                Funded by: National Cheng Kung University Hospital, doi 10.13039/501100004844;
                Award ID: NCKUH-11204010
                Categories
                Original Article
                Lower Limb

                in hospital mortality,geriatric fracture,distal femur fracture,risk factor,delay to surgery

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