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Introduction: Our study aims to assess post-intervention and pre-operative mortality in patients admitted to our institute diagnosed with a fractured proximal femur. The influence of comorbidity on prognosis in the short (1 month), medium (3 month) and long term (6 month) was assessed between July 2006 and July 2009., Materials and Methods: The 238 patients (85 men and 153 women), between 65- and 99-year-old, were followed-up as outpatients and by telephone for 1 year to monitor the state of persistence in life or eventually the date of death. The comorbidity parameters considered were: sex, age, ASA class of anesthetic risk, fracture location and type of surgical treatment used, the number of previous associated diseases and the presence/absence of cognitive impairment on admission., Results: The data obtained, in comparison with that of the general population in the Lazio region (ISTAT table), showed. Higher mortality rate in men than women, high mortality rate for patients with cognitive impairment at admission (50%), mortality over twice as high in patients belonging to ASA classes III and IV than in patients belonging to the lower categories. By observing the time between surgery and death it was also evident that the first 6-month period was the most critical; furthermore, 45.45% of deaths occurred within the first 60 days., Conclusions: Identifying the causes that influence the mortality of our patients and being able to quantify the relevance in subsequent death enables us to improve the care for the risk, strengthen the therapeutic choices based on new evidence, and especially lay the groundwork for the development of new treatment protocols, useful for clinical and forensing decision-making.

Objectives: to compare the assistance delivered to elderly persons (age 65 +) hospitalized in 1999-2003 after femur fracture between two Italian regions (Lazio and Tuscany). Indicators derived from current databases have been used., Main Outcomes: 1) age-standardized proportion of patients treated surgically; 2) age-standardized proportion of patients with surgery within 2 days from admission among all the patients with surgery; 3) age-standardized proportion of deaths within 30 days from admission., Methods: incident cases and patients undergoing surgery were retrieved from abstract discharge records, while deaths were traced through record linkage with mortality registers., Results: in the period covered by the study, 32019 incident cases occurred in Lazio region and 30406 in Tuscany. The analysis shows better results for Tuscany for each indicator. In 2003, the age-standardized proportions of patients treated surgically were 83.0% in Lazio and 86.2% in Tuscany. The age-standardized proportion of patients undergoing surgery within 2 days from admission were respectively 14.7%, and 29.8%. The age-standardized proportions of deaths occurring within 30 days from admission were 5.0% and 2.8%. Lazio shows higher proportions of deaths both for patients with and without surgery., Conclusions: the use of the same procedure based on purely administrative data (available at national level) provides confidence on the reliability of the comparison between the two regions. Similar low-budget studies may easily be extended to other geographical areas.

The death rate 6 and 12 months after surgery in 389 patients who had been treated for fracture of the proximal femur between 1989 and 1993 (1st semester) was studied. All of the patients submitted to surgery were traced through the official records on the population of the City of Padova. The overall death rate after 6 months was 16%, that after 12 months 23%. The best survival rate was observed in patients who had been submitted to gamma nail arthroplasty (p < 0.01).

The authors compare the results obtained in a group of 100 patients submitted to pertrochanteric osteosynthesis during the year 1991 (50 with a gamma nail and 50 with a compression-sliding plate) based on parameters of anesthesiology. The same type of anesthesiology was used in all 100 of the patients, as similar were the general clinical conditions of the patients, ASA classification, and the mean value of preoperative hemoglobin. The gamma nail proved to be preferable in terms of a shorter amount of time required for surgery, a minor loss of blood intra and postoperatively, and minor incidence of complications.