Retrospektive Mortalitätsanalyse geriatrischer unfallchirurgisch-orthopädischer Patienten der Universitätsmedizin Göttingen zwischen 2013 und 2017
by Jamina Apel
Date of Examination:2025-08-14
Date of issue:2025-08-18
Advisor:PD Dr. Daniel Hoffmann
Referee:PD Dr. Daniel Hoffmann
Referee:Prof. Dr. Roland Nau
Persistent Address:
http://dx.doi.org/10.53846/goediss-11437
Files in this item
Name:Apel_Jamina_Dissertation_ediss.pdf
Size:1.11Mb
Format:PDF
The following license files are associated with this item:
Abstract
English
Due to demographic change, the number of older patients in trauma surgery and orthopedics is steadily increasing. Comorbidities and age-related changes such as reduced physical and mental adaptability in geriatric patients make their treatment very complex and mortality high. In recent years, there has therefore been increased research into interdisciplinary treatment of older patients and possible approaches to reducing mortality. However, critical time intervals with an increased risk of in-hospital mortality after the acute phase have not yet been established. Since knowledge about this and about the factors influencing mortality is essential for a possible reduction in in-hospital mortality in older patients, this study was conducted. This study is a retrospective study conducted at the University Medical Center Göttingen, in which data from 6,201 trauma surgery and orthopedic patients over the age of 60 from 2013 to 2017 were collected and analyzed. The aim was to analyze in-hospital mortality and investigate factors influencing mortality. In addition, a critical in-hospital time interval with an increased risk of mortality after the acute phase was defined and evaluated. Overall, this study found an in-hospital mortality rate of 2.7%. In the statistical analysis, the parameters treatment method, age, presence of a resistant pathogen, day of discharge, and discharge ward showed a significant influence on mortality. The in-hospital mortality rate did not differ significantly between treatment methods (surgery: 2.8%; conservative therapy: 2.5%), while the other significant parameters had a clear influence on mortality in some cases. The in-hospital mortality rate increased with age (60-69 years: 1.3%; over 80 years: 4.7%). The presence of a resistant pathogen also significantly reduced the survival rate according to the data collected in this study. With regard to the day of discharge, more patients died on a weekend or public holiday than on a weekday, regardless of the treatment method. The different discharge wards represented a special feature in this study, so that the focus was placed on the normal ward with regard to in-hospital mortality. The in-hospital mortality rate in the normal ward was 0.6% for the entire patient population (operated patients: 0.5%; conservatively treated patients: 0.8%). The parameters “gender,” “type of admission,” and “day of admission” had no statistically significant influence on mortality. The results of this study show that there appears to be a critical time interval after the acute phase with an increased risk of mortality for geriatric trauma surgery and orthopedic patients. In this study, this was determined for the entire patient population from day 10 to day 21. For the group of patients who underwent surgery, a critical time interval from day 13 to day 26 was identified, and for patients treated conservatively, from day 4 to day 13. Further studies are needed to examine the influence of other parameters on the critical time interval, as the patient population sizes of deceased patients were too small for more in-depth analyses.
Keywords: geriatric; mortality; elderly; geriatric assessment; orthopedics; trauma surgery; frailty; in-hospital mortality
