Die mortalitat von alten menschen nach huftgelenksnahen femurfrakturen. Ein vergleich der zeitraume von 1986 bis 1991 und 1992 bis 1997

After the first report on the mortality in old patients with fractures of the hip in the Surgical Department of the Medical University of Lubeck 1986 to 1991 (period A), now, the years 1992 to 1997 were studied. The factors of mortality were analyzed to compare any changes to the first period. In this report, we studied 62 new patients with fracture of the proximal femur, who were no less than 75 years old and who died during their hospitalization in the Department of Surgery of the Medical University of Lubeck 1992 to 1997 (period B). The number of patients increased drastically from 498 (period A) to 883 patients in period B. The mortality remained with 7% (62/883) almost the same as in period A with 6% (30/498). In contrast to that former period, the patients showed significantly more preexisting diseases in the later period B. The significant increase of general anesthesia in 75.8% (47/62) of all operations (period B) instead of 8.3% (2/24) in period A did not affect adversely. The number of operated patients significantly increased from 70% (21/30) in period A to 92% (57/62) in period B, whereas the rate of revisions did not exceed 12.3% (7/57), which means a not significant increase in comparison to period A with 9.5% (2/21). Apart from the higher incidence of preexisting diseases even the number of postoperative/posttraumatical complications increased, which can be judged as a growing multimorbidity in these patients. The time of treatment on the intensive care unit increased significantly from 19% (79/418 days) in period A up to 40% (394/986 days) in period B of the total hospitalization time. Consecutively, the average time on the ICU raised from 4 to 7 days. The mean time of death remained almost the same at the 13th to 14th postoperative/posttraumatical day. The most frequent cause of death was cardiac failure, which significantly raised from 46.7% (14/30) in period A to 77.4% (48/62) in period B, whereas pulmonary, cause of death occurred only in 12.9% (8/62) in comparison to period A with 40% (12/30). In period A, the analysis of those factors that finally caused death, reflected the great influence of the trauma itself. 30% (9/30) of the patients could not be operated and died of the indirect complications of the fracture like immobility and confinement to bed with a lot of adversed consequences (pneumonia, decubitus and others). In contrast to that, the increasing number of surgical fracture treatment shows the attempt to withhold the negative influence of the confinement to bed and immobility caused by non-surgical therapy. Although immobility, as the most significant risk factor, was almost completely removed, it becomes obvious that the comorbidity as well as the postoperative/posttraumatical complications are still the limitating factors to the healing process of the old surgical patient.