Hip fracture surgery and survival in centenarians: results from an Italian healthcare utilization database

Background and aims. According to the WHO, life expectancy in Italy is among the highest in the world. Within the geriatric population, centenarians (aged ≥100 years old) represent the age subgroup with the highest rate of increase. Hip fracture (HF) is a frequent cause of hospitalization in the elderly, and its incidence grows exponentially with age. Among many studies on HF, those focusing on centenarians are very limited. Aiming to outline the incidence of HF and survival after surgery in a real-life setting, we investigated a cohort of centenarians living in Lombardy, a highly populated Northern Italian region. Methods. Retrospective longitudinal cohort study based on the Lombardy Healthcare Utilization Database. Between 2004 and 2011 we identified 7,830 centenarians, who accounted for 286 hospitalizations for HF surgery. We paired each HF patient 1:1 with a comparator subject, randomly selected from the initial cohort to be matched for age and gender, and who did not experience HF. Results. Despite similar baseline features, HF patients had more hospitalizations for all causes (53.4% vs. 18.6%, p<0.001), HF re-hospitalizations (16.7% vs. 2.7%, p<0.001), and deaths (77.3% vs. 60.6%, p<0.001) during follow-up. Survival was significantly lower in HF patients than in comparators (31.0% vs. 47.6%, p<0.001). Conclusions. Kaplan-Meier curves showed higher mortality in HF patients than in comparators, but the crucial period is represented by the first three months after surgery. The systematic adoption of comprehensive orthogeriatric approaches could help improving the centenarians’ short-term mortality rate, but especially their functional outcomes and their quality of life