Effect of surgical treatment on mortality after acetabular fracture in the elderly: A multicenter study of 454 patients

Joshua L. Gary, Ebrahim Paryavi, Steven D. Gibbons, Michael J. Weaver, Jordan H. Morgan, Scott P. Ryan, Adam J. Starr, Robert V. O'Toole

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objectives: Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Our hypothesis was that operative treatment would confer a mortality benefit compared with nonoperative treatment even after adjusting for comorbidities associated with death. Design: Retrospective study. Setting: Three University Level I Trauma Centers. Patients/Participants: All patients aged 60 years and older with acetabular fractures treated from 2002 to 2009 were included in the study. Four hundred fifty-four patients were identified with an average age of 74 years. Sixty-seven percent of the study group was male and 33% female. Intervention: One of 4 treatments: nonoperative management with early mobilization, percutaneous reduction and fixation, open reduction and internal fixation, acute total hip arthroplasty. Main Outcome Measurements: Kaplan-Meier survival curves were created, and Cox proportional hazards models were used to calculate unadjusted and adjusted hazard ratios (HRs) for covariates of interest. Results: In contrast to previous smaller studies, the overall mortality was relatively low at 16% at 1 year [95% confidence interval (CI), 13-19]. Unadjusted survivorship curves suggested higher 1-year mortality rates for nonoperatively treated patients (21% vs. 13%, P < 0.001); however, nonoperative treatment was associated with other risk factors for higher mortality. By accounting for these patient risk factors, our final multivariate model of survival demonstrated no significant difference in hazard of death for nonoperative treatment (0.92, P = 0.6) nor for any of the 3 operative treatment subgroups (P range, 0.4-0.8). As expected, we did find a significantly increased hazard for factors such as the Charlson comorbidity index [HR, 1.25 per point (95% CI, 1.16-1.34)] and age [HR, 1.08 per year of age more than 70 years (95% CI, 1.05-1.11)]. In addition, associated fracture patterns (compared with elementary patterns) significantly increased the hazard of death with a ratio of 1.51 (95% CI, 1.10-2.06). Conclusions: The operative treatment of acetabular fractures does not increase or decrease mortality, once comorbidities are taken into account. The reasons for this are unknown. Regardless of the causes, the decision for operative versus nonoperative treatment of geriatric acetabular fractures should not be justified based on the concern for increased or decreased mortality alone.

Original languageEnglish (US)
Pages (from-to)202-208
Number of pages7
JournalJournal of Orthopaedic Trauma
Volume29
Issue number4
DOIs
StatePublished - Apr 21 2015

Fingerprint

Multicenter Studies
Mortality
Confidence Intervals
Comorbidity
Therapeutics
Early Ambulation
Trauma Centers
Kaplan-Meier Estimate
Proportional Hazards Models
Arthroplasty
Geriatrics
Hip
Survival Rate
Retrospective Studies
Survival

Keywords

  • Acetabulum
  • Geriatric
  • Mortality
  • Nonoperative
  • Open reduction internal fixation
  • Percutaneous
  • Total hip arthroplasty
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Gary, J. L., Paryavi, E., Gibbons, S. D., Weaver, M. J., Morgan, J. H., Ryan, S. P., ... O'Toole, R. V. (2015). Effect of surgical treatment on mortality after acetabular fracture in the elderly: A multicenter study of 454 patients. Journal of Orthopaedic Trauma, 29(4), 202-208. https://doi.org/10.1097/BOT.0000000000000223

Effect of surgical treatment on mortality after acetabular fracture in the elderly : A multicenter study of 454 patients. / Gary, Joshua L.; Paryavi, Ebrahim; Gibbons, Steven D.; Weaver, Michael J.; Morgan, Jordan H.; Ryan, Scott P.; Starr, Adam J.; O'Toole, Robert V.

In: Journal of Orthopaedic Trauma, Vol. 29, No. 4, 21.04.2015, p. 202-208.

Research output: Contribution to journalArticle

Gary, Joshua L. ; Paryavi, Ebrahim ; Gibbons, Steven D. ; Weaver, Michael J. ; Morgan, Jordan H. ; Ryan, Scott P. ; Starr, Adam J. ; O'Toole, Robert V. / Effect of surgical treatment on mortality after acetabular fracture in the elderly : A multicenter study of 454 patients. In: Journal of Orthopaedic Trauma. 2015 ; Vol. 29, No. 4. pp. 202-208.
@article{88b1237cb83243ffac9b045a6d0f6d8c,
title = "Effect of surgical treatment on mortality after acetabular fracture in the elderly: A multicenter study of 454 patients",
abstract = "Objectives: Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Our hypothesis was that operative treatment would confer a mortality benefit compared with nonoperative treatment even after adjusting for comorbidities associated with death. Design: Retrospective study. Setting: Three University Level I Trauma Centers. Patients/Participants: All patients aged 60 years and older with acetabular fractures treated from 2002 to 2009 were included in the study. Four hundred fifty-four patients were identified with an average age of 74 years. Sixty-seven percent of the study group was male and 33{\%} female. Intervention: One of 4 treatments: nonoperative management with early mobilization, percutaneous reduction and fixation, open reduction and internal fixation, acute total hip arthroplasty. Main Outcome Measurements: Kaplan-Meier survival curves were created, and Cox proportional hazards models were used to calculate unadjusted and adjusted hazard ratios (HRs) for covariates of interest. Results: In contrast to previous smaller studies, the overall mortality was relatively low at 16{\%} at 1 year [95{\%} confidence interval (CI), 13-19]. Unadjusted survivorship curves suggested higher 1-year mortality rates for nonoperatively treated patients (21{\%} vs. 13{\%}, P < 0.001); however, nonoperative treatment was associated with other risk factors for higher mortality. By accounting for these patient risk factors, our final multivariate model of survival demonstrated no significant difference in hazard of death for nonoperative treatment (0.92, P = 0.6) nor for any of the 3 operative treatment subgroups (P range, 0.4-0.8). As expected, we did find a significantly increased hazard for factors such as the Charlson comorbidity index [HR, 1.25 per point (95{\%} CI, 1.16-1.34)] and age [HR, 1.08 per year of age more than 70 years (95{\%} CI, 1.05-1.11)]. In addition, associated fracture patterns (compared with elementary patterns) significantly increased the hazard of death with a ratio of 1.51 (95{\%} CI, 1.10-2.06). Conclusions: The operative treatment of acetabular fractures does not increase or decrease mortality, once comorbidities are taken into account. The reasons for this are unknown. Regardless of the causes, the decision for operative versus nonoperative treatment of geriatric acetabular fractures should not be justified based on the concern for increased or decreased mortality alone.",
keywords = "Acetabulum, Geriatric, Mortality, Nonoperative, Open reduction internal fixation, Percutaneous, Total hip arthroplasty, Trauma",
author = "Gary, {Joshua L.} and Ebrahim Paryavi and Gibbons, {Steven D.} and Weaver, {Michael J.} and Morgan, {Jordan H.} and Ryan, {Scott P.} and Starr, {Adam J.} and O'Toole, {Robert V.}",
year = "2015",
month = "4",
day = "21",
doi = "10.1097/BOT.0000000000000223",
language = "English (US)",
volume = "29",
pages = "202--208",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Effect of surgical treatment on mortality after acetabular fracture in the elderly

T2 - A multicenter study of 454 patients

AU - Gary, Joshua L.

AU - Paryavi, Ebrahim

AU - Gibbons, Steven D.

AU - Weaver, Michael J.

AU - Morgan, Jordan H.

AU - Ryan, Scott P.

AU - Starr, Adam J.

AU - O'Toole, Robert V.

PY - 2015/4/21

Y1 - 2015/4/21

N2 - Objectives: Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Our hypothesis was that operative treatment would confer a mortality benefit compared with nonoperative treatment even after adjusting for comorbidities associated with death. Design: Retrospective study. Setting: Three University Level I Trauma Centers. Patients/Participants: All patients aged 60 years and older with acetabular fractures treated from 2002 to 2009 were included in the study. Four hundred fifty-four patients were identified with an average age of 74 years. Sixty-seven percent of the study group was male and 33% female. Intervention: One of 4 treatments: nonoperative management with early mobilization, percutaneous reduction and fixation, open reduction and internal fixation, acute total hip arthroplasty. Main Outcome Measurements: Kaplan-Meier survival curves were created, and Cox proportional hazards models were used to calculate unadjusted and adjusted hazard ratios (HRs) for covariates of interest. Results: In contrast to previous smaller studies, the overall mortality was relatively low at 16% at 1 year [95% confidence interval (CI), 13-19]. Unadjusted survivorship curves suggested higher 1-year mortality rates for nonoperatively treated patients (21% vs. 13%, P < 0.001); however, nonoperative treatment was associated with other risk factors for higher mortality. By accounting for these patient risk factors, our final multivariate model of survival demonstrated no significant difference in hazard of death for nonoperative treatment (0.92, P = 0.6) nor for any of the 3 operative treatment subgroups (P range, 0.4-0.8). As expected, we did find a significantly increased hazard for factors such as the Charlson comorbidity index [HR, 1.25 per point (95% CI, 1.16-1.34)] and age [HR, 1.08 per year of age more than 70 years (95% CI, 1.05-1.11)]. In addition, associated fracture patterns (compared with elementary patterns) significantly increased the hazard of death with a ratio of 1.51 (95% CI, 1.10-2.06). Conclusions: The operative treatment of acetabular fractures does not increase or decrease mortality, once comorbidities are taken into account. The reasons for this are unknown. Regardless of the causes, the decision for operative versus nonoperative treatment of geriatric acetabular fractures should not be justified based on the concern for increased or decreased mortality alone.

AB - Objectives: Controversy exists regarding the effect of operative treatment on mortality after acetabular fracture in elderly patients. Our hypothesis was that operative treatment would confer a mortality benefit compared with nonoperative treatment even after adjusting for comorbidities associated with death. Design: Retrospective study. Setting: Three University Level I Trauma Centers. Patients/Participants: All patients aged 60 years and older with acetabular fractures treated from 2002 to 2009 were included in the study. Four hundred fifty-four patients were identified with an average age of 74 years. Sixty-seven percent of the study group was male and 33% female. Intervention: One of 4 treatments: nonoperative management with early mobilization, percutaneous reduction and fixation, open reduction and internal fixation, acute total hip arthroplasty. Main Outcome Measurements: Kaplan-Meier survival curves were created, and Cox proportional hazards models were used to calculate unadjusted and adjusted hazard ratios (HRs) for covariates of interest. Results: In contrast to previous smaller studies, the overall mortality was relatively low at 16% at 1 year [95% confidence interval (CI), 13-19]. Unadjusted survivorship curves suggested higher 1-year mortality rates for nonoperatively treated patients (21% vs. 13%, P < 0.001); however, nonoperative treatment was associated with other risk factors for higher mortality. By accounting for these patient risk factors, our final multivariate model of survival demonstrated no significant difference in hazard of death for nonoperative treatment (0.92, P = 0.6) nor for any of the 3 operative treatment subgroups (P range, 0.4-0.8). As expected, we did find a significantly increased hazard for factors such as the Charlson comorbidity index [HR, 1.25 per point (95% CI, 1.16-1.34)] and age [HR, 1.08 per year of age more than 70 years (95% CI, 1.05-1.11)]. In addition, associated fracture patterns (compared with elementary patterns) significantly increased the hazard of death with a ratio of 1.51 (95% CI, 1.10-2.06). Conclusions: The operative treatment of acetabular fractures does not increase or decrease mortality, once comorbidities are taken into account. The reasons for this are unknown. Regardless of the causes, the decision for operative versus nonoperative treatment of geriatric acetabular fractures should not be justified based on the concern for increased or decreased mortality alone.

KW - Acetabulum

KW - Geriatric

KW - Mortality

KW - Nonoperative

KW - Open reduction internal fixation

KW - Percutaneous

KW - Total hip arthroplasty

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=84925588251&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925588251&partnerID=8YFLogxK

U2 - 10.1097/BOT.0000000000000223

DO - 10.1097/BOT.0000000000000223

M3 - Article

C2 - 25233162

AN - SCOPUS:84925588251

VL - 29

SP - 202

EP - 208

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

IS - 4

ER -