Mortality Rate After Hip Fracture at Age 80
The 1-year mortality rate for an 80-year-old patient with a hip fracture is approximately 15-30%, representing a three-fold increase compared to the general geriatric population of the same age. 1, 2
Specific Mortality Timeline
- 30-day mortality: 8.4%, with up to half of these deaths potentially preventable 1, 2
- 6-month mortality: Approximately 50% of deaths occur within the first 6 months post-fracture 3
- 1-year mortality: 15-30% overall, with the highest risk concentrated in the immediate post-fracture period that gradually decreases but remains elevated throughout the entire first year 1, 2
The mortality risk is highest immediately after fracture and progressively declines, though it remains substantially elevated compared to age-matched individuals without hip fracture for months to years following the injury. 1
Critical Risk Factors That Modify Mortality at Age 80
Sex Differences
- Male patients have significantly worse outcomes: 37.5-38% mortality at 1 year compared to 24-28% in women 4, 1
- Men face substantially higher risk of death following hip fracture than women, attributed to excess comorbidity burden and higher infection rates 4
Age-Specific Considerations
- At 80 years old, patients fall into the high-risk category, with mortality rates of 19% being highest in those ≥86 years 2
- The standard mortality ratio (comparing hip fracture patients to the general population) is actually highest for younger elderly patients (<70 years) and lowest for those >80 years, suggesting that very advanced age somewhat "normalizes" the relative mortality impact 5
Comorbidity Impact
- Dementia: Acts synergistically with hip fracture to exacerbate 1-year mortality risk, particularly in younger elderly cohorts 6
- Dementia prevalence is extremely high (85%) in hip fracture patients compared to other surgical patients (61.5%) 7
- Greater comorbidity burden and frailty independently increase death risk 1
- Sarcopenia is the strongest predictor of out-of-hospital mortality (hazard ratio 4.77) 1, 2
Factors That Reduce Mortality
Early surgical intervention within 24-48 hours significantly reduces both short-term and mid-term mortality rates. 4, 1, 8
- Delays beyond 48 hours increase mortality, with the effect becoming more pronounced as delay extends 8
- Delays beyond even 12 hours significantly increase the adjusted risk of 30-day mortality 2, 8
Orthogeriatric comanagement on dedicated orthogeriatric wards has been shown to achieve the shortest time to surgery, shortest length of inpatient stay, and lowest inpatient and 1-year mortality rates. 4
Long-Term Mortality Beyond 1 Year
- The increased relative risk for mortality remains elevated for months and perhaps even years following hip fracture, though it becomes less pronounced with time 1
- Patients face a 3- to 4-fold increased risk of mortality in the 5 years following hip fracture 1
- By the second year after fracture, the mortality rate approaches that of the general population (standard mortality ratio approaches unity) 5
Common Pitfalls to Avoid
- Do not delay surgery for minor medical optimization: There is no evidence that delaying surgery to allow pre-operative physiological stabilization improves outcomes 8
- Recognize preventable deaths: Up to 50% of postoperative deaths may be potentially preventable through optimized acute management 1, 2
- Address pain immediately: Appropriate pain management should be provided before starting diagnostic investigations, as early fracture fixation provides the most effective analgesia 4
- Screen for dementia: Dementia is vastly under-diagnosed in elderly hospitalized patients and is a major risk factor for both hip fracture occurrence and post-fracture mortality 7, 6