Comorbidity burden, management, and in-hospital outcomes in centenarians with proximal hip fracture: a nationwide cohort study (2004–2020)

Abstract

Summary: This study analyses comorbidity, surgical management, and complications and their impact on in-hospital outcomes in centenarian hip fracture patients admitted in Spain, 2004–2020. It provides evidence on the prognostic impact of comorbidity and in-hospital complications and highlights the need for specific interventions to improve care in this vulnerable population. Purpose: This work aims to describe the clinical characteristics, in-hospital progress, and risk factors for worse in-hospital outcomes in centenarian patients with proximal hip fracture (PHF). Methods: A retrospective nationwide cohort study was conducted that included all centenarian patients hospitalized for PHF (2004–2020) according to the Spanish National Health System’s Minimum Basic Data Set. Demographic, clinical, and hospitalization-related variables were analyzed. Univariate and multivariate analyses were performed. Results: This study included 4261 patients (83.3% women). The mean Charlson comorbidity index (CCI) was 0.9 ± 1.2; 11.4% had severe comorbidity. Surgery was performed in 87.2% of patients and in 44.5% after 48 h of admission. Higher CCI scores (OR 1.3, 95% CI 1.0–1.7) and admission to medical departments (OR 4.11, 95% CI 3.0–5.6) were associated with nonsurgical management. Surgical delays ≥ 48 h were associated with admissions on Saturdays (OR 1.9, 95% CI 1.3–2.8) or to medical departments (OR 2.79, 95% CI 1.34–5.83) and with the development of ≥ 3 complications (OR 1.5, 95% CI 1.1–2.0). Overall, 15% of patients died during hospitalization, with significantly higher mortality in nonsurgical patients (31.8% vs. 12.5%, p < 0.001). In surgical patients, mortality and prolonged hospital stays were primarily related to higher CCI scores and complications. Conclusions: Centenarians with PHF have a low severe disease burden but high in-hospital mortality risk. Key predictors of mortality in surgical patients include higher CCI scores and in-hospital complications. This highlights the relevance of integrated care and early optimization of clinical status. Prospective studies with long-term follow-up are needed to better characterize prognostic factors.