Hip Fractures challenge Geriatric Patients - Analysis of Surgical Factors

Background:
The global demographic shift towards an ageing population is leading to a marked increase in hip fractures, projected to rise from 1.26 million cases in 1990 to approximately 4.5 million by 2050. More than 90% of these injuries occur in patients older than 65 years. Given the frequent multimorbidity, polypharmacy, and reduced physiological and cognitive reserves in this population, hip fractures represent a major clinical challenge and are often associated with loss of independence and increased mortality.

Methods:
We conducted a prospective observational cohort study including 281 geriatric patients treated for hip fractures on a dedicated geriatric trauma unit. Demographic data, surgical variables (time to surgery, implant type, and surgical invasiveness), and pre-existing risk factors (anemia, dementia, anticoagulation therapy, malnutrition assessed by the Nutritional Risk Score [NRS], and ASA classification) were analyzed. Outcomes included mobility, living situation as a marker of independence, and 120-day mortality.

Results:
Preoperative patient-related factors showed the strongest association with outcome. Anticoagulation therapy, malnutrition, and higher ASA classification were significantly associated with increased mortality and reduced functional recovery. Pre-existing anemia correlated with poorer outcomes, whereas minimal perioperative hemoglobin levels did not demonstrate a significant association with outcome parameters. Surgical factors such as time to surgery and implant characteristics showed less pronounced effects compared to baseline patient condition.

Conclusion:
In geriatric hip fracture patients, pretraumatic health status appears to be a stronger determinant of functional outcome and mortality than acute surgical variables. These findings highlight a potential window for preoperative optimization strategies targeting nutrition, anemia management, and anticoagulation-related risk stratification to improve patient outcomes.