Preoperative predictors of mortality in fractures of the proximal femur

BACKGROUND: Age and comorbidities are considered independent preoperative predictors of mortality in proximal femoral fractures; however, their contribution remains debatable. AIM: To assess the prognostic significance of age and Charlson Comorbidity Index (CCI) of the survival of older people with proximal femoral fractures. MATERIALS AND METHODS: This retrospective prospective study included all cases of proximal femoral fractures that occurred between January 1, 2019, and December 31, 2019, in individuals over 50 years of age from the cities of Tver, Torzhok, Rzhev, VyshnyVolochek, and Kashin. ICD-10 codes: S72.0, S72.1, and S72.2. The CCI of each patient was calculated using an online calculator and clinical data obtained from patient and outpatient records. Statistical analysis. Survival was estimated using Kaplan–Meier curves and the average number of deaths per day per 1000 people. The follow-up interval was obtained in days from the time of injury to the event of death or last contact with the patient. The minimum observation period was 876 days, and the maximum was 1492 days. RESULTS: The survival rate of patients decreased from younger to older age groups, both among those operated on and those who were not. Patients aged ≥85 years were at greatest risk (median survival: 257 days; 95% CI: 36.6–478.3). CCI was significantly associated with survival: the risk of death with CCI 3 was 3–6 times higher than that with CCI 2–3, depending on the follow-up interval. CCI reflected health status more than age: within the same age group, there were patients with different CCIs. CONCLUSION: Using age and CCI simultaneously as predictors of mortality and more accurate indicators of health status will enable the planning of the utilization of additional medical and social resources in the preoperative and postoperative periods, thereby increasing survival.