Mortality of Nonoperatively Managed Geriatric Pelvic Ring Fractures

Objective The purpose of this investigation was to identify the mortality rate at three months and one year for patients 65 years old or older with a nonoperatively managed pelvic ring fracture. Materials and methods A retrospective comparative cohort study was performed at a single level 1 trauma tertiary referral center. From 2014 to 2019, we reviewed all patients older than 65 years who underwent nonoperative treatment for a pelvic ring fracture (Current Procedural Terminology codes 27193 or 27197). Demographics, including age, sex, body mass index (BMI), and Charlson Comorbidity Index (CCI), were recorded. Mortality status and death dates were determined from our institutional electronic health record and cross-referenced with the TriNetX database (Cambridge, MA, USA). The primary outcome was the standardized mortality ratio (SMR) for one-year mortality, calculated by comparing observed deaths in the study population with expected deaths in the age- and sex-matched general population. Secondary outcomes included three-month and one-year mortality rates, as well as demographic variables associated with mortality. Results A total of 307 patients met the inclusion criteria. There were 41 (13.4%) that died within three months and 77 (25.1%) that died within 1 year. Compared to the general population, pelvic ring fracture patients demonstrated an SMR of 3.12 (95% confidence interval: 2.46, 3.85) for one-year mortality. Compared with patients alive at three months post-injury, deceased patients did not differ significantly in age (80.9 ± 8.6 vs. 81.0 ± 9.7 years; p = 0.964), BMI (24.3 ± 5.2 vs. 25.9 ± 5.9; p = 0.062), or sex (p = 0.507). Alive patients had a lower mean CCI compared to deceased patients (5.4 ± 2.1 vs. 6.8 ± 2.8; p < 0.001). At one year, deceased patients did not demonstrate statistically significant age differences (80.5 ± 8.5 vs. 82.4 ± 9.5 years; p = 0.103), BMI (24.5 ± 5.3 vs. 24.5 ± 5.5; p = 0.922), or sex (p = 0.835), and alive patients had a lower mean CCI (5.2 ± 2.0 vs. 6.6 ± 2.6; p < 0.001). Conclusions Geriatric patients who undergo nonoperative treatment of pelvic ring fractures have a threefold higher one-year mortality compared to their age- and sex-matched peers who do not have pelvic ring fractures. There is an association between mortality and higher comorbidity burden, and clinicians should counsel patients on the elevated risk of post-injury mortality based on comorbidity status. This has implications for counseling patients and their families, as such an approach may inform surgical decision-making and ensure that treatment plans are tailored to the patient's overall health and prognosis.