AUTHOR=Tiso Debora , Pizzonia Monica , Giannotti Chiara , Tagliafico Luca , Signori Alessio , Nencioni Alessio , Monacelli Fiammetta 

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

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1200007

DOI=10.3389/fmed.2023.1200007

ISSN=2296-858X

ABSTRACT=It’s still undetermined whether ultra persons aged >90 years ( ultra old)  are able to tolerate hip fracture  surgical stress, maintaining their functional reserve and even fewer evidence has 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 IRCCS Policlinico San Martino, Hospital (Genoa, Italy), that consecutively enrolled  205 old age patients with hip fractures due to low-energy trauma. Namely,  85 patients were ultra old and 120 patients (64-89 years) were considered the younger control group. Demographic data, perioperative data and rehabilitation were collected.Here we estimated the overall survival  and the associated predictive variables  in hospitalized ultra-old hip fractured patients based on a methodologically robust frailty stratification ( Rockwood 40 items).
The median OS for ultra-old was 18.7 months  and, similarly, they showed a double fold  1 year mortality risk. Our findings assessed that frailty in presence of malnutrition, delayed verticalization and post- operative respiratory complications  were associated with a double-fold risk increase for long-term mortality, irrespective of advanced chronological age in ultra old.Although the higher mortality rate in those patients may be related to a priori lower life expectancy, chronological age alone is a insufficient prognostic determinant for unfavourable outcomes. Our multicomponent prognostic score may be apply in combination to frailty stratification  to ultra-old to timely screen for and deliver goals of care discussions prior to surgery, targeting potentially new orthogeriatric  pathways for the improvement of appropriateness and  treatment intensity.