Factors Influencing Geriatric Orthopaedic Trauma Mortality |
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| Affiliation: | 1. Penn State College of Medicine, Hershey, PA, 17033 USA;2. Department of Orthopaedics and Rehabilitation, Penn State Hershey Medical Center, Hershey, PA, 17033 USA;3. Public Health Sciences, Penn State College of Medicine, Hershey, PA, 17033 USA;4. Department of Anesthesiology, University of Utah, Salt Lake City, UT, 84132 USA;1. Shenzhen University General Hospital, Shenzhen 518060, China;2. Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen 518060, China.;3. The Department of Orthopedics, The Second Affiliated Hospital of Air Force Medical University, Xi''an 710000, China.;1. Department of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, United States;2. Kamuzu Central Hospital, Lilongwe, Malawi;1. Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women''s hospital, Boston, United States;2. St. Antonius Hospital, Dpt. of Trauma Surgery, Utrecht, the Netherlands;3. Leiden University Medical Center, Dpt. of Clinical Epidemiology, Leiden, the Netherlands;4. Leiden University Medical Center, Dpt. of Biomedical Data Sciences, Leiden, the Netherlands;1. Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan;2. Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan;3. Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan;4. Department of Orthopedic Surgery, Chikamori Hospital, Kochi, Japan;5. Department of Orthopedic Surgery, Okayama Saiseikai General Hospital, Okayama, Japan;6. Department of Orthopaedic Surgery and Traumatology, Kawasaki Medical School General Medical Center, Okayama, Japan;7. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan |
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| Abstract: | IntroductionThis study aimed to: (1) evaluate the independent risk factors related to survival and mortality and (2) predict survival in geriatric orthopaedic trauma patients admitted to our institution's ICU as a Level 1 or 2 trauma activation.MethodsA retrospective review was performed on patients age >60, over a 10 year period, who were involved in a multi-trauma with orthopaedic injuries. Variables evaluated include: sex, age, Injury Severity Score (ISS), mechanism of injury, number and type of orthopaedic injury, anticoagulant use, comorbidities, length of stay in intensive care unit (ICU), type of ICU, ventilator use, vasopressors use, incidence of multiple organ dysfunction syndrome (MODS), number of surgeries, and 1-month and 6-month mortality. A Kaplan-Meier estimator and Cox proportional hazards analysis were used to predict and assess survival probability.Results174 patients were included, with an average mortality of 47.7%. Deceased patients had a significantly greater age, ISS, vasopressor usage, ICU stay, incidence of MODF, incidence of genitourinary disease, anticoagulant usage, ventilator usage, number of orthopaedic surgeries, and orthopaedic injuries. The relative risk for mortality within the first month was significantly associated with increased age, ISS, high-energy trauma, length of ICU stay, MODS, psychiatric disease, and anticoagulant use. Patients with an ISS ≤30 were significantly more likely to survive than patients with an ISS of >30. Greater age, ISS, length of ICU stay, incidence of MODS, anticoagulant, and ventilator use were significantly predictive of lower survival rates. Mechanism of injury, number of orthopaedic surgeries and orthopaedic injuries, and type of orthopaedic injury were not found to be predictive of survival.ConclusionsAn ISS >30 at admission is strongly predictive of a lower probability of survival. Genitourinary disease was associated with increased mortality. Low age, ISS, length of stay in ICU, incidence of MODS, anticoagulant use, and ventilator use, are significantly predictive of survival. Number of orthopaedic surgeries, orthopaedic injuries, and type of orthopaedic injury were not found to be predictive of survival. These indications help us to better understand factors predictive of death among geriatric orthopaedic trauma patients, and improve the way we can diagnose and care for them. |
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