Which hip fracture patients choose surgery after extensive shared-decision-making but pass away within one year?

Introduction

Hip fracture patients with limited life expectancy can opt for Palliative, Non-Operative Management (P-NOM). It is unknown which patients still have a poor prognosis following hip fracture surgery after extensive shared decision-making on P-NOM. This study aimed to describe frail geriatric hip fracture patients who, after extensive SDM in acute setting, opt for operative management yet pass away within 12 months after surgery.

Methods

A retrospective cohort study was conducted where all hip fracture patients receiving surgery in our regional teaching hospital between 01-08-2020 and 01-08-2022 were eligible for inclusion. Included patients were aged 70 years or above and were deceased within one year following hip fracture surgery. The primary outcome were the baseline characteristics of included patients. Secondary outcomes were data on mortality and shared decision-making.

Results

In total, 827 hip fracture patients were admitted, from which 94 (11,4%) patients opted for P-NOM. Eventually 733 patients underwent hip fracture surgery and 140 (19%) patients died within one year after surgery. These surgically treated patients had a median age of 86 years (81-91), 70 patients were female (50%), the median Charlson Comorbidity Index was 6 (5-7), the median length of stay was 6 days (5-10), the median prognosis was 61 days till death (13-189) and the in-hospital and 30-day mortality was 20 (14,3%) and 55 (39,4%), respectively.

Conclusion

After extensive SDM, the mortality following hip fracture surgery remains high (19%). Patients who die within one year are of old age, have multiple comorbidities and many die within 30 days following surgery. It is unknown why these patients opted for surgery instead of P-NOM. Future research should focus on examining the reasons of these patients for choosing surgery and identifying accurate predictors for mortality for patients choosing for hip fracture surgery after extensive SDM.

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