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Ultra-old patients and long-term survival after hip fracture: a real-world assessment

It’s still undetermined whether ultra-old persons, aged >90 years, are able to tolerate hip fracture surgical stress while maintaining their functional reserve, and even fewer studies have investigated the role of frailty on the risk of mortality, disability, or morbidity in the ultra-old. This i...

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Autores principales: Tiso, Debora, Pizzonia, Monica, Giannotti, Chiara, Tagliafico, Luca, Signori, Alessio, Nencioni, Alessio, Monacelli, Fiammetta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406208/
https://www.ncbi.nlm.nih.gov/pubmed/37554502
http://dx.doi.org/10.3389/fmed.2023.1200007
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author Tiso, Debora
Pizzonia, Monica
Giannotti, Chiara
Tagliafico, Luca
Signori, Alessio
Nencioni, Alessio
Monacelli, Fiammetta
author_facet Tiso, Debora
Pizzonia, Monica
Giannotti, Chiara
Tagliafico, Luca
Signori, Alessio
Nencioni, Alessio
Monacelli, Fiammetta
author_sort Tiso, Debora
collection PubMed
description It’s still undetermined whether ultra-old persons, aged >90 years, are able to tolerate hip fracture surgical stress while maintaining their functional reserve, and even fewer studies have investigated the role of frailty on the risk of mortality, disability, or morbidity in the ultra-old. This is a prospective study performed at the Orthogeriatrics Ward of the IRCCS Policlinico San Martino (Genoa, Italy) that consecutively enrolled 205 older adult patients with hip fractures due to low-energy trauma. Namely, 85 patients were categorized as ultra-old, and 120 patients (64–89 years) were the younger control group. Demographic data, perioperative data, and rehabilitation data were collected. Here we estimated the overall survival and related predictive variables in hospitalized ultra-old hip fracture patients based on a methodologically robust frailty stratification (Rockwood 40-item tool). The median OS for the ultra-old was 18.7 months, which also showed a doubled 1-year mortality risk. Our findings assessed that frailty in the presence of malnutrition, delayed verticalization, and post-operative respiratory complications was associated with a two-fold increase in the risk of long-term mortality, irrespective of advanced chronological age in the ultra-old. Although the higher mortality rate in these patients may be related to a priori lower life expectancy, chronological age alone is an insufficient prognostic determinant for unfavorable outcomes. Our multicomponent prognostic score can be used in combination to stratify frailty in the ultra-old for timely screening and to deliver goals of care discussions prior to surgery, potentially targeting new orthogeriatric pathways for the improvement of appropriateness and treatment intensity.
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spelling pubmed-104062082023-08-08 Ultra-old patients and long-term survival after hip fracture: a real-world assessment Tiso, Debora Pizzonia, Monica Giannotti, Chiara Tagliafico, Luca Signori, Alessio Nencioni, Alessio Monacelli, Fiammetta Front Med (Lausanne) Medicine It’s still undetermined whether ultra-old persons, aged >90 years, are able to tolerate hip fracture surgical stress while maintaining their functional reserve, and even fewer studies have investigated the role of frailty on the risk of mortality, disability, or morbidity in the ultra-old. This is a prospective study performed at the Orthogeriatrics Ward of the IRCCS Policlinico San Martino (Genoa, Italy) that consecutively enrolled 205 older adult patients with hip fractures due to low-energy trauma. Namely, 85 patients were categorized as ultra-old, and 120 patients (64–89 years) were the younger control group. Demographic data, perioperative data, and rehabilitation data were collected. Here we estimated the overall survival and related predictive variables in hospitalized ultra-old hip fracture patients based on a methodologically robust frailty stratification (Rockwood 40-item tool). The median OS for the ultra-old was 18.7 months, which also showed a doubled 1-year mortality risk. Our findings assessed that frailty in the presence of malnutrition, delayed verticalization, and post-operative respiratory complications was associated with a two-fold increase in the risk of long-term mortality, irrespective of advanced chronological age in the ultra-old. Although the higher mortality rate in these patients may be related to a priori lower life expectancy, chronological age alone is an insufficient prognostic determinant for unfavorable outcomes. Our multicomponent prognostic score can be used in combination to stratify frailty in the ultra-old for timely screening and to deliver goals of care discussions prior to surgery, potentially targeting new orthogeriatric pathways for the improvement of appropriateness and treatment intensity. Frontiers Media S.A. 2023-07-24 /pmc/articles/PMC10406208/ /pubmed/37554502 http://dx.doi.org/10.3389/fmed.2023.1200007 Text en Copyright © 2023 Tiso, Pizzonia, Giannotti, Tagliafico, Signori, Nencioni and Monacelli. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Tiso, Debora
Pizzonia, Monica
Giannotti, Chiara
Tagliafico, Luca
Signori, Alessio
Nencioni, Alessio
Monacelli, Fiammetta
Ultra-old patients and long-term survival after hip fracture: a real-world assessment
title Ultra-old patients and long-term survival after hip fracture: a real-world assessment
title_full Ultra-old patients and long-term survival after hip fracture: a real-world assessment
title_fullStr Ultra-old patients and long-term survival after hip fracture: a real-world assessment
title_full_unstemmed Ultra-old patients and long-term survival after hip fracture: a real-world assessment
title_short Ultra-old patients and long-term survival after hip fracture: a real-world assessment
title_sort ultra-old patients and long-term survival after hip fracture: a real-world assessment
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406208/
https://www.ncbi.nlm.nih.gov/pubmed/37554502
http://dx.doi.org/10.3389/fmed.2023.1200007
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