Outcomes of nonagenarians undergoing hip fracture surgery: a multicentre observational study across Asia-Oceana
Rattachement africain : my, au, th, kr. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Nonagenarians with hip fracture represent a rapidly growing, highly vulnerable subgroup, yet comparative data across diverse health‑care systems in Asia‑Oceania are scarce. We aimed to describe mortality, postoperative complications, and perioperative care patterns in nonagenarians undergoing hip fracture surgery in Australia and Malaysia, and to explore associations between key perioperative factors and mortality. METHODS: We conducted a binational, retrospective, multicentre observational study of consecutive nonagenarians (aged ≥ 90 to < 100 years) who underwent surgery for unilateral femoral neck, intertrochanteric, or subtrochanteric fractures at four tertiary training hospitals (one in Australia, three in Malaysia) between January 2016 and January 2021. Patient demographics, comorbidities, frailty, surgical and anaesthetic details, and postoperative complications were extracted from electronic records; complications were graded using the Clavien–Dindo classification. Primary outcomes were in‑hospital, 30‑day, and 1‑year mortality; secondary outcomes were number and severity of postoperative complications, length of hospital stay, and 30‑day readmission. Statistical analyses focused on descriptive comparisons and cohort-stratified exploratory analyses to explore associations between perioperative factors and mortality. RESULTS: Among 510 patients, 394 (77.3%) were treated in Australia and 116 (22.7%) in Malaysia; median age was 92.0 years (interquartile range 91.0–94.0). Baseline profiles and perioperative care differed substantially: Malaysian patients more often had hypertension, diabetes, and chronic kidney disease, whereas Australian patients more frequently had congestive heart failure and dementia, and underwent emergency surgery within 48 h. In‑hospital and 30‑day mortality were similar between Australia and Malaysia (6.3% vs. 6.9% and 8.6% vs. 10.3%, respectively), but 1‑year mortality was higher in Malaysia (36.0% vs. 14.7%; P < 0.001). Overall, 86.0% of patients experienced at least one postoperative complication, with higher rates in Australia than Malaysia (98.3% vs. 49.1%), while severe complications (Clavien–Dindo grade ≥ III) were comparable (15.0% vs. 15.5%). Median length of stay was similar (8 days in both cohorts), but 30‑day readmission was more frequent in Malaysia (28.7% vs. 2.7%; P < 0.001). In cohort‑stratified models, factors associated with mortality differed by country and time point; no single perioperative factor was consistently associated with mortality across settings. CONCLUSIONS: In this binational cohort of nonagenarians undergoing hip fracture surgery, short‑term mortality was comparable across four tertiary hospitals in Australia and Malaysia, whereas 1‑year mortality and early readmission were substantially higher in Malaysia. These findings suggest that system‑level factors, including delayed access to surgery and limited coordinated post‑acute care, may be important determinants of longer‑term outcomes in this very old population, and highlight the need for context‑specific strategies to optimise hip fracture care in resource‑diverse settings.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Outcomes of nonagenarians undergoing hip fracture surgery: a multicentre observational study across Asia-Oceana
- Date Crossref
- 19/02/2026
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Malaya pays non établi dans la noticeUniversité ou école supérieure
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Hospital Kuala Lumpur pays non établi dans la noticeÉtablissement de santé
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University Kebangsaan Malaysia Medical Centre pays non établi dans la noticeÉtablissement de santé
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National University of Malaysia pays non établi dans la noticeUniversité ou école supérieure
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Austin Health pays non établi dans la noticeÉtablissement de santé
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Siriraj Hospital Department of Anesthesiology pays non établi dans la noticeÉtablissement de santé
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Mahidol University pays non établi dans la noticeUniversité ou école supérieure
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Dongguk University Ilsan Hospital Department of Anesthesiology and Pain Medicine pays non établi dans la noticeÉtablissement de santé
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The University of Melbourne Department of Critical Care pays non établi dans la noticeUniversité ou école supérieure
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Faculty of Medicine Department of Anaesthesiology pays non établi dans la noticeUniversité ou école supérieure
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Hospital Canselor Tuanku Muhriz Department Anaesthesiology & Intensive Care pays non établi dans la noticeÉtablissement de santé
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Hospital Raja Permaisuri Bainun Department of Anaesthesiology pays non établi dans la noticeÉtablissement de santé
University of Malaya, Hospital Kuala Lumpur et University Kebangsaan Malaysia Medical Centre, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.