World J Surg Surg Res | Volume 4, Issue 1 | Research Article | Open Access

Surgical Treatment of Intertrochanteric Fractures in Elderly Patients: Comparing the Effect of Age vs. Physical Status on Patient Outcomes

Ghulam H Saadat1*, Theofilos Karasavvidis2, Daniel Alsoof3, Ante Rebic4, Dana Scott Lycans5, Frederic Starr1 and Faran Bokhari1

1Department of Trauma and Burn Surgery, John H Stroger Hospital of Cook County, USA
2Department of Medicine and Health Sciences, Aristotle University of Thessaloniki, Greece
3University College London, UK
4Kansas City University, USA
5Department of Orthopedic Surgery, Marshall University School of Medicine, USA

*Correspondance to: Ghulam H Saadat 

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Purpose: The purpose of this study was to compare the impact of age and physical status on short
term (≤ 30 days) outcomes of Intertrochanteric Fracture (ITF) in elderly patients. The primary
outcome of our study was mortality. Secondary outcomes included short term complications.
Methods: This retrospective cohort study includes patients from the American College of Surgeons
National Quality Improvement Program (ACS NSQIP) from January 2016 to December 2018.
All patients with ITF treated with Intramedullary Nail (IMN) fixation were included in the study.
Patients were divided into two age cohorts: 65 to 75 years and 76 to 89 years old. Patients' physical
status was assessed by the American Society of Anesthesiologists (ASA) Classification System.
Results: A total of 14,278 patients met the inclusion criteria: 3,811 patients were between 65 to
75 years, and 10,467 patients were 76 to 89 years old. Overall, the mortality rate was 1.9%. After
adjusting for gender, Body Mass Index (BMI), functional status, and ASA class, age 76 to 89
years were not associated with mortality (OR=1.2, P=0.24). However, age 76 to 89 years were
significantly associated with higher rates of blood transfusion (OR=1.36, P <0.001), myocardial
infarction (OR=1.76, P<0.001), and urinary tract infection (OR=1.24, P=0.05). The adjusted
odds ratio of mortality for patients with ASA class III and ASA Class IV/V was 2.86 (P<0.001)
and 10.51 (P<0.001), respectively. Similarly, patients with ASA Class 4/5 had a significantly higher
rate of transfusion (OR=2.1, P=0.00), pneumonia (OR=3.43, P<0.001), stroke (OR=2.31, P=0.01),
myocardial infarction (OR=2.96, P<0.001), urinary tract infection (OR=1.66, P<0.001), renal
failure/insufficiency (OR=8.7, P<0.001), sepsis (OR=2.4, P<0.001), surgical site infections (OR=3.82,
P<0.001), readmission (OR=2.73, P<0.001) and revision surgery (OR=1.94, P<0.001).
Conclusion: This study has shown that patients aged 76 to 89 years had no increased risk of 30-day
mortality compared with the 65 to 75 years old age group. Data showed that in intertrochanteric
fractures patients' physical status was a more reliable predictor of adverse outcomes than age.


Hip fractures; Geriatrics; Age; Physical status; Comorbidities


Saadat GH, Karasavvidis T, Alsoof D, Rebic A, Lycans DS, Starr F, et al. Surgical Treatment of Intertrochanteric Fractures in Elderly Patients: Comparing the Effect of Age vs. Physical Status on Patient Outcomes. World J Surg Surgical Res. 2021; 4:

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