Abstract
Introduction
More than 60% of patients presenting with a hip fracture have significant medical co-morbidities and a one year mortality rate between 14% and 47%. The rating scale for the American Society of Anaesthetists (ASA) is a reliable predictor of both surgical risk and mortality with ASA 4 patients having 100% mortality at one year.1,2
Aims
Our aim was to establish a mortality rate for fractured neck of femur patients at three months and twelve months, and to ascertain the mortality of patients with an ASA 4 grading. Ultimately, should we be operating on this high risk cohort of patients'. We also chose to analyse our current practice in the management of displaced intracapsular neck of femur fractures in patients 90 years of age and over.
Methods
Over 300 patients with a fractured neck of femur were identified between the 1st January 2007 and the 1st January 2008. A retrospective case note review of 151 patients was performed in conjunction with the NHS mortality database to establish whether each patient was alive or deceased. Our findings were compared to the standards set which included an overall mortality of 20% at three months, 30% at twelve months and 100% mortality for ASA 4 patients at twelve months.
Results
Five patients were excluded from the study as one patient had incomplete data and four patients died prior to intended surgery. Only one of these patients had an ASA 4 grading. 146 patients were included and 23 patients (15.7%) were ASA 4. The overall mortality was 16% at three months and 23% at twelve months which was within the limits of the standards set. ASA 4 patients had a mortality of 57% at three months and 65% at twelve months which compared favourably with the limited literature available. There were 11 patients who were 90 years of age and over with intracapsular neck of femur fractures. Three of these patients were treated with a cemented hemiarthroplasty and were all alive at twelve months.
Conclusions
Our study demonstrates a much better mortality rate in the ASA 4 patients than the limited literature available would suggest. We believe that ASA 4 patients should continue to be offered surgical intervention and that this data provides us with information to allow the patient and family to reach an informed decision with regard to their treatment. Intracapsular neck of femur fractures in patients 90 years of age and over can be treated with a cemented hemiarthroplasty provided they are deemed fit.
