Does operative treatment of geriatric pelvic ring injuries lead to a high risk of one-year mortality?

Benjamin M Wheatley; Adeet Amin; Mark C Miller; Stephen J Warner; Daniel T Altman; Milton Lee Chip Routt Jr

doi:10.1016/j.injury.2021.06.023

Does operative treatment of geriatric pelvic ring injuries lead to a high risk of one-year mortality?

Injury. 2021 Oct;52(10):2973-2977. doi: 10.1016/j.injury.2021.06.023. Epub 2021 Jul 1.

Authors

Benjamin M Wheatley¹, Adeet Amin², Mark C Miller³, Stephen J Warner², Daniel T Altman⁴, Milton Lee Chip Routt Jr²

Affiliations

¹ Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, United States. Electronic address: benjamin.m.wheatley.mil@mail.mil.
² Department of Orthopedic Surgery, University of Texas Health Sciences Center, Houston, TX, United States.
³ Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, United States; Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, United States.
⁴ Department of Orthopedic Surgery, Allegheny Health Network, Pittsburgh, PA, United States.

PMID: 34246482
DOI: 10.1016/j.injury.2021.06.023

Abstract

Introduction: Non-operative management of pelvic ring injuries in the elderly is associated with a high risk of one-year mortality. The majority of these injuries are the result of a low-energy mechanism, however, due to the multiple medical comorbidities in this patient population the injuries are associated with a high degree of morbidity. The purpose of this study was to determine the one-year mortality risk after operative treatment of pelvic ring injuries in a geriatric patient population and the effect of patient and injury characteristics on the risk of mortality.

Patients and methods: We performed a retrospective review of patients over the age of 70 who underwent operative fixation of a pelvic ring injury at two Level 1 trauma centers between January 2016 and June 2019. Medical records were reviewed for patient and injury characteristics including: Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) physical status score or Injury Severity Score (ISS), hospital and intensive care unit (ICU) length of stay (LOS). The primary outcome of interest was the one-year mortality risk following operative treatment. Secondary outcomes included the effect of patient and injury characteristics on the one-year mortality risk and the hospital LOS.

Results: Ninety patients were included with an average age of 79.8 ± 6.5 years. The overall mortality was 8.9% (n = 8) and was significantly associated with the CCI. There was no significant effect related to the ASA physical status score or ISS. The average hospital LOS was 9.2 ± 7.3 days and was associated with the CCI, ASA physical status score, and ISS.

Discussion: Non-operative management of pelvic ring injuries in geriatric patients is associated with a high risk of one-year mortality. Our findings suggest operative treatment of these fractures is associated with an acceptable risk of one-year mortality that falls below the commonly reported range for non-operatively managed injuries. Furthermore, the risk of mortality was significantly associated with the patient's pre-injury state as determined by the CCI.

Keywords: Geriatric trauma; Length of stay; Mortality; Operative treatment; Pelvic ring injury.

MeSH terms

Aged
Aged, 80 and over
Fractures, Bone* / surgery
Humans
Injury Severity Score
Length of Stay
Pelvic Bones* / surgery
Retrospective Studies
Trauma Centers