Predictive factors for one-year postoperative mortality in patients over 80 years old with femoral neck fractures

doi:10.3877/ cma.j.issn.1674-134X.2025.01.003

Abstract

Abstract:

Objective

To identify risk factors affecting one-year postoperative mortality in patients aged 80 years and older with femoral neck fractures.

Methods

This study used a retrospective case-control study on the patients who underwent surgical treatment for femoral neck fractures in our hospital from January 2019 to December 2023.Inclusion criteria: patients age ≥80 years old; femoral neck fracture; no obvious surgical contraindications; independent ambulation or ambulation with assistive devices before injury; good compliance.Exclusion criteria: pathological fractures; high-energy trauma; patients with old fractures (time from injury to surgery longer than three weeks); incomplete clinical data.Baseline characteristics, medical history,and prior medication use were studied.Relevant clinical parameters, including the Charlson comorbidity index,American Society of Anesthesiologists (ASA) grading, Barthel index, and functional activity questionnaire (FAQ)score were analyzed.Clinical data and comorbidities were recorded during follow-up.The survival rate was evaluated using the Kaplan-Meier method.Variables influencing survival were assessed by Cox regression model.Hazard ratios (HR) and 95% confidence intervals (CI) for each factor were calculated.

Results

According to the inclusion and exclusion criteria, a total of 152 patients were included in this study, with 31 in the death group.The 1-year postoperative mortality rate was 20.4%, and the median survival period was 10.1 (9.2, 10.5)months.There were statistically significant differences in age (t=3.778, P<0.001), FAQ score (Z=-4.377,P<0.05), Barthel index (t=15.240, P<0.001), preoperative use of anticoagulants (χ²=4.977, P<0.05), and international normalized ratio INR (t=11.621, P<0.001) between the two groups.There was no statistically significant difference in other indicators such as ASA grading (χ²=1.127, P=0.277) between the two groups.Cox regression analysis showed that age ≥87 years ［HR=3.5, 95% CI=(1.9,7.9), P<0.001］, Barthel index<85 points ［HR=4.0, 95% CI (1.3,12.7), P<0.05］, and pre admission use of anticoagulant drugs with INR≥1.5 ［HR=3.7, 95% CI (2.1,7.7), P<0.05］ were statistically significant predictors of first-year mortality after surgery.

Conclusions

For patients aged 80 years or older undergoing surgery for femoral neck fractures, the predictive factors for death in the first year after surgery were age ≥87 years, Barthel index score ≤85, and taking anticoagulants with an INR ≥1.5 before admission.

Key words: Femoral neck fracture, Arthroplasty, replacement, hip, Aged, Risk factors, Mortality

Ying Pi, Qiang Zhang, Zhirong Huang. Predictive factors for one-year postoperative mortality in patients over 80 years old with femoral neck fractures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 13-20.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/ cma.j.issn.1674-134X.2025.01.003

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2025/V19/I01/13

Figures/Tables 5

Table 1 General data of the enrolled patients

指标Characteristics	死亡组Death group	非死亡组Non death grou	统计值Statistical values	P值
例数 Number of cases	31	121
年龄［岁,（ x±s）］ Age (year)	88. 7±4. 7	85. 7±3. 7	t=3. 778	＜0. 001
性别（男/女） Gender (male/female)	11/20	26/95	χ ^²=1. 167	>0. 05
身体质量指数［kg/m^²,（ $\overset{ˉ}{x}$ ±s）］Body mass index	27. 0±2. 7	26. 2±1. 9	t=0. 271	>0. 05
Charlson指数［M（Q₂₅，Q₇₅）］Charlson index	1. 3(1. 0，1. 6)	1. 6(1. 2，2. 1)	Z=-1. 718	>0. 05
FAQ评分 FAQ scores［M（Q₂₅，Q₇₅）］	4. 5(3. 7，6. 1)	3. 3(2. 1，4. 7)	Z=-4. 377	＜0. 05
ASA［例（%）］
Ⅰ	2(6. 5)	9(7. 4)
Ⅱ	27(87. 1)	111(91. 7)
Ⅲ	2(6. 5)	1(0. 8)	χ ^²=1. 127	>0. 05
Barthel指数 Barthel index（ $\overset{ˉ}{x}$ ±s）	57. 8±19. 5	72. 9±16. 7	t=15. 240	＜0. 001
抗血小板聚集药［例（%）］ Antiplatelet drugs	4(12. 9)	21(18. 2)	χ ^²=0. 877	>0. 05
抗凝药［例（%）］ Anticoagulants	8(25. 8)	10(8. 3)	χ ^²=4. 977	0. 023
血红蛋白［ g/L（, $\overset{ˉ}{x}$ ±s）］ Hemoglobin	119. 0±21. 0	125. 0±16. 0	t=0. 747	>0. 05
红细胞比容Hematocrit value［%,（ $\overset{ˉ}{x}$ ±s）］	36. 0±3. 3	37. 1±3. 7	t=0. 645	>0. 05
INR （x±s）	2. 1±1. 2	1. 2±0. 8	t=11. 621	＜0. 001
血小板计数［10⁹ 个/L,（x±s）］ Platelet counts	220. 8±55. 7	212±70. 7	t=0. 829	>0. 05
Garden分型［例（%）］ Garden classification	26(83. 4)	99(81. 8)	χ ^²=2. 517	>0. 05
手术时间 Operation time［ min,（ $\overset{ˉ}{x}$ ±s）］	87. 7±29. 7	91. 9±22. 7	t=1. 126	>0. 05
关节置换/内固定［例（%）］Hipreplacement/internal fixation	27(87. 1)	97(80. 2)	χ ^²=2. 738	>0. 05
术中并发症［例（%）］ Intraoperative Complications	0	3(2. 5)	χ ^²=3. 018	>0. 05
术后24 h血红蛋白［g/L（, $\overset{ˉ}{x}$ ±s）］Postoperative 24h hemoglobin	9. 5±2. 2	9. 6±1. 7	t=1. 769	>0. 05
术后24h红细胞比容［%,（ $\overset{ˉ}{x}$ ±s）］Postoperative 24h hematocrit	27. 8±5. 3	28. 9±4. 0	t=0. 877	>0. 05
输血［例（%）］ Blood transfusion	16(51. 6)	48(40. 0)	t=0. 910	>0. 05
住院时间［d（, $\overset{ˉ}{x}$ ±s）］ Length of hospital stay	9. 8±4. 2	8. 0±2. 7	t=1. 177	>0. 05
内植物相关并发症［例（%）］Complications of internal implants	2(6. 5)	6(5. 0)	χ ^²=2. 037	>0. 05

Table 1 General data of the enrolled patients

指标Characteristics	死亡组Death group	非死亡组Non death grou	统计值Statistical values	P值
例数 Number of cases	31	121
年龄［岁,（ x±s）］ Age (year)	88. 7±4. 7	85. 7±3. 7	t=3. 778	＜0. 001
性别（男/女） Gender (male/female)	11/20	26/95	χ ^²=1. 167	>0. 05
身体质量指数［kg/m^²,（ $\overset{ˉ}{x}$ ±s）］Body mass index	27. 0±2. 7	26. 2±1. 9	t=0. 271	>0. 05
Charlson指数［M（Q₂₅，Q₇₅）］Charlson index	1. 3(1. 0，1. 6)	1. 6(1. 2，2. 1)	Z=-1. 718	>0. 05
FAQ评分 FAQ scores［M（Q₂₅，Q₇₅）］	4. 5(3. 7，6. 1)	3. 3(2. 1，4. 7)	Z=-4. 377	＜0. 05
ASA［例（%）］
Ⅰ	2(6. 5)	9(7. 4)
Ⅱ	27(87. 1)	111(91. 7)
Ⅲ	2(6. 5)	1(0. 8)	χ ^²=1. 127	>0. 05
Barthel指数 Barthel index（ $\overset{ˉ}{x}$ ±s）	57. 8±19. 5	72. 9±16. 7	t=15. 240	＜0. 001
抗血小板聚集药［例（%）］ Antiplatelet drugs	4(12. 9)	21(18. 2)	χ ^²=0. 877	>0. 05
抗凝药［例（%）］ Anticoagulants	8(25. 8)	10(8. 3)	χ ^²=4. 977	0. 023
血红蛋白［ g/L（, $\overset{ˉ}{x}$ ±s）］ Hemoglobin	119. 0±21. 0	125. 0±16. 0	t=0. 747	>0. 05
红细胞比容Hematocrit value［%,（ $\overset{ˉ}{x}$ ±s）］	36. 0±3. 3	37. 1±3. 7	t=0. 645	>0. 05
INR （x±s）	2. 1±1. 2	1. 2±0. 8	t=11. 621	＜0. 001
血小板计数［10⁹ 个/L,（x±s）］ Platelet counts	220. 8±55. 7	212±70. 7	t=0. 829	>0. 05
Garden分型［例（%）］ Garden classification	26(83. 4)	99(81. 8)	χ ^²=2. 517	>0. 05
手术时间 Operation time［ min,（ $\overset{ˉ}{x}$ ±s）］	87. 7±29. 7	91. 9±22. 7	t=1. 126	>0. 05
关节置换/内固定［例（%）］Hipreplacement/internal fixation	27(87. 1)	97(80. 2)	χ ^²=2. 738	>0. 05
术中并发症［例（%）］ Intraoperative Complications	0	3(2. 5)	χ ^²=3. 018	>0. 05
术后24 h血红蛋白［g/L（, $\overset{ˉ}{x}$ ±s）］Postoperative 24h hemoglobin	9. 5±2. 2	9. 6±1. 7	t=1. 769	>0. 05
术后24h红细胞比容［%,（ $\overset{ˉ}{x}$ ±s）］Postoperative 24h hematocrit	27. 8±5. 3	28. 9±4. 0	t=0. 877	>0. 05
输血［例（%）］ Blood transfusion	16(51. 6)	48(40. 0)	t=0. 910	>0. 05
住院时间［d（, $\overset{ˉ}{x}$ ±s）］ Length of hospital stay	9. 8±4. 2	8. 0±2. 7	t=1. 177	>0. 05
内植物相关并发症［例（%）］Complications of internal implants	2(6. 5)	6(5. 0)	χ ^²=2. 037	>0. 05

Figure 1 Kaplan-Meier survival curve with 1-year mortality as the end point

Figure 2 Bilateral hip joints X ray images at anteroposterior view of two patients with femoral neck fractures after two surgeries in the death group.A is the image of the first patient 10 months after internal fixation surgery for right femoral neck fracture, showing the avascular necrosis of the right femoral head; B is image of the first patient after total hip replacement for right hip, showing the artificial total hip joint in place and both lower limbs being of similar length; C is image of the second patient after artificial femoral head replacement for left femoral neck fracture, showing periprosthetic fracture of left femur; D is image after internal fixation for the left femoral fracture of the second patient, showing that the fracture fragment was firmly fixed and the prosthesis was not loose

Table 2 Factors related to survival divided by groups

因素 Factors		例数Number of cases	中位生存期（95%CI）Median survival(95% CI)	Z值	P值
年龄	≥87岁	50	8. 3（7. 7，10. 7）	-5. 774	＜0. 001
Age	＜87岁	102	11. 1（10. 5，11. 9）
Barthel指数	≥85	94	11. 7（11. 0，12. 6）	-5. 104	＜0. 001
Barthel index	＜85	58	9. 3（8. 3，10. 7）
FAQ评分	≥5	55	9. 0（7. 7，11. 1）	-3. 127	＜0. 01
FAQ scores	＜5	97	10. 7（9. 1，11. 9）
使用抗凝剂	是	18	7. 3（5. 5，9. 9）	-3. 771	0. 007
Anticoagulants	否	134	10. 9（9. 7，11. 7）
INR	≥1. 5	27	8. 1（6. 9，9. 2）	-4. 250	＜0. 001
	＜1. 5	125	11. 0（10. 1，12. 3）
	否否	118	Ref	-	-
抗凝药+INR ≥1. 5	否是	7	10. 1（8. 1，12. 2）	-	＜0. 001
Anticoagulants and INR≥1. 5	是否	116	1. 3（0. 8，1. 3）	-	0. 357
	是是	11	9. 7（7. 7，11. 2）	-4. 117	0. 007

Table 3 Multivariate analysis ofCox proportional hazards model

因素 Factors	回归系数Regression coeffcient	HR（95% CI）	P值
年龄 Age
≥87	1. 294	3. 5（1. 9，7. 9）	＜0. 001
＜87
Barthel指数Barthel index
≥85	1. 400	4. 0（1. 3，12. 7）	0. 027
＜5
FAQ评分FAQ scores
≥5	0. 577	1. 7（0. 8，3. 5）	0. 277
＜5
抗凝药+INR ≥1. 5Anticoagulants andINR ≥1. 5
≥1. 5	1. 220	3. 7（2. 1，7. 7）	0. 005
＜1. 5

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