{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:41:33Z","timestamp":1788183693719,"version":"build-2803163510"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Policy-Guided Project of Liaocheng Key Research and Development Program"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Studies comparing the clinical characteristics and outcomes among different age groups in elderly patients with hip fractures are scarce. Thus, this study aimed to 1) analyze the clinical characteristics and postoperative outcomes among different age groups in elderly patients undergoing fracture surgery. 2) provide more evidence-based basis for perioperative management.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In the retrospective study, 909 patients aged 65 years and above who underwent hip fracture surgery at Liaocheng People\u2019s Hospital between October 2020 and April 2023 were categorized into three groups based on age: young old group (YO group, 65\u201374 years old), middle old group (MO group, 75\u201384 years old), and oldest-old group (OO group,\u2009\u2265\u200985 years old). Then, their pre-fracture conditions, fracture causes and type, anesthesia and surgical details, postoperative complication and outcomes were compared.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In the YO, MO, and OO groups, the male-to-female ratios were 1:2.1, 1:1.8, and 1:2.3, respectively (<jats:italic><jats:italic>P<\/jats:italic>\u2009<\/jats:italic>=<jats:italic>\u2009<\/jats:italic>0.293). The proportion of patients with American Society of Anesthesiologists (ASA) \u2265 III, Nottingham hip fracture score (NHFS) \u2265 5 and preoperative activity tolerance\u2009&lt;\u20094 metabolic equivalents (METs) increased sequentially (<jats:italic><jats:italic>P<\/jats:italic>\u2009<\/jats:italic>&lt;\u20090.001), across the YO, MO, and OO groups, whereas the proportion of those with three or more internal medicine comorbidities sequentially decreased (<jats:italic><jats:italic>P<\/jats:italic>\u2009<\/jats:italic>&lt;\u20090.001). All three groups were primarily injured by falls and the older the age, the higher the proportion of injuries caused by falls (<jats:italic><jats:italic>P<\/jats:italic>\u2009<\/jats:italic>=\u20090.006). There was a higher proportion of femoral neck fractures in the YO group and a higher incidence of intertrochanteric fracture in the OO group (<jats:italic><jats:italic>P<\/jats:italic>\u2009<jats:italic>&lt;<\/jats:italic><\/jats:italic>\u20090.001). The proportion of patients undergoing spinal anesthesia in the HO group (78.8%) was higher than that in the MO (59.9%) and YO groups (55.1%) (<jats:italic><jats:italic>P<\/jats:italic><\/jats:italic>\u2009&lt;\u20090.001). Additionally, the proportion of postoperative intensive care unit (ICU) admissions (10%) was higher in the OO group compared to the MO (6.2%) and YO groups (4.5%) (<jats:italic><jats:italic>P<\/jats:italic>\u2009<\/jats:italic>=\u20090.032). Meanwhile, the incidence of postoperative complications progressively increased in the YO, MO, and OO groups (<jats:italic><jats:italic>P<\/jats:italic><\/jats:italic>\u2009&lt;\u20090.001). The mortality rates of the HO group at the hospital, 30 days postoperatively, and 90 days postoperatively were 6.3%, 9.6%, and 13.3%, respectively, which were significantly higher than those of the MO (2.7%, 3.6%, 6.2%) and the YO groups (1.2%, 1.8%, 2.4%) (<jats:italic><jats:italic>P<\/jats:italic><\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The majority of elderly patients undergoing hip fracture surgery were female, with falls being the predominant cause of injury. Increasing age was correlated with poorer preoperative mobility, a lower prevalence of three or more comorbidities, and a higher likelihood of receiving spinal anesthesia. Lastly, the probability of ICU admission, complications, and mortality rate increased after surgery.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333909","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T17:30:54Z","timestamp":1760549454000},"page":"e0333909","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparison of clinical characteristics and outcomes among different age groups in elderly patients with hip fracture surgery"],"prefix":"10.1371","volume":"20","author":[{"given":"Qingwen","family":"Cao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lize","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingzhi","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenlong","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoran","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7208-8123","authenticated-orcid":true,"given":"Ailan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"issue":"8","key":"pone.0333909.ref001","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1002\/jbmr.4881","article-title":"Hip fractures and aging: a global problem requiring coordinated global solutions","volume":"38","author":"PR Ebeling","year":"2023","journal-title":"J Bone Miner Res"},{"issue":"3","key":"pone.0333909.ref002","doi-asserted-by":"crossref","first-page":"111377","DOI":"10.1016\/j.injury.2024.111377","article-title":"Osteosynthesis, hemiarthroplasty, total hip arthroplasty in hip fractures: All I need to know","volume":"55","author":"M Ridha","year":"2024","journal-title":"Injury"},{"issue":"8","key":"pone.0333909.ref003","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1002\/jbmr.4821","article-title":"Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality","volume":"38","author":"C-W Sing","year":"2023","journal-title":"J Bone Miner Res"},{"key":"pone.0333909.ref004","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.d3304","article-title":"Management of hip fracture in adults: summary of NICE guidance","volume":"342","author":"S Ftouh","year":"2011","journal-title":"BMJ"},{"issue":"20","key":"pone.0333909.ref005","doi-asserted-by":"crossref","DOI":"10.5435\/JAAOS-D-22-00273","article-title":"AAOS Management of Hip Fractures in Older Adults Evidence-based Clinical Practice Guideline","volume":"30","author":"JA Switzer","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"issue":"4","key":"pone.0333909.ref006","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s00198-023-06942-0","article-title":"Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery","volume":"35","author":"M Bui","year":"2024","journal-title":"Osteoporos Int"},{"key":"pone.0333909.ref007","doi-asserted-by":"crossref","first-page":"110844","DOI":"10.1016\/j.injury.2023.110844","article-title":"Clinical data or scoring system for predicting mortality in elderly patients with hip fracture: A prospective study","author":"RMC de Souza","year":"2023","journal-title":"Injury"},{"issue":"10305","key":"pone.0333909.ref008","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/S0140-6736(21)01921-8","article-title":"Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis","volume":"398","author":"Collaboration Blood Pressure Lowering Treatment Trialists\u2019","year":"2021","journal-title":"Lancet"},{"key":"pone.0333909.ref009","article-title":"Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries","volume":"373","author":"N Islam","year":"2021","journal-title":"BMJ"},{"key":"pone.0333909.ref010","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.resuscitation.2020.05.005","article-title":"Age-specific trends in incidence and survival of out-of-hospital cardiac arrest from presumed cardiac cause in Denmark 2002-2014","volume":"152","author":"M Winther-Jensen","year":"2020","journal-title":"Resuscitation"},{"issue":"5","key":"pone.0333909.ref011","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1007\/s00198-017-3926-2","article-title":"Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients","volume":"28","author":"A Padr\u00f3n-Monedero","year":"2017","journal-title":"Osteoporos Int"},{"issue":"2","key":"pone.0333909.ref012","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/j.1447-0594.2012.00908.x","article-title":"Estimation of functional recovery in patients after hip fracture by Berg Balance Scale regarding the sex, age and comorbidity of participants","volume":"13","author":"N Radosavljevic","year":"2013","journal-title":"Geriatr Gerontol Int"},{"issue":"1","key":"pone.0333909.ref013","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4103\/0019-5413.38577","article-title":"Comparison of the prognosis among different age groups in elderly patients with hip fracture","volume":"42","author":"T Hagino","year":"2008","journal-title":"Indian J Orthop"},{"issue":"4","key":"pone.0333909.ref014","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s00402-016-2422-z","article-title":"Patient characteristics and outcomes of a hip fracture and concomitant fracture compared with hip fracture alone: results from a United Kingdom teaching hospital","volume":"136","author":"T Ong","year":"2016","journal-title":"Arch Orthop Trauma Surg"},{"issue":"6","key":"pone.0333909.ref015","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.eprac.2023.03.001","article-title":"Age-Related Factors Associated With The Risk of Hip Fracture","volume":"29","author":"P Buzkova","year":"2023","journal-title":"Endocr Pract"},{"issue":"3","key":"pone.0333909.ref016","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2020.07.013","article-title":"Prediction of postoperative outcomes following hip fracture surgery: independent validation and recalibration of the nottingham hip fracture score","volume":"22","author":"WJ Doherty","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0333909.ref017","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.2147\/CIA.S321287","article-title":"Validation of the Nottingham Hip Fracture Score (NHFS) in Patients with Hip Fracture: A Prospective Cohort Study in the Netherlands","volume":"16","author":"Dutch Hip Fracture Registry Collaboration","year":"2021","journal-title":"Clin Interv Aging"},{"issue":"12","key":"pone.0333909.ref018","first-page":"897","article-title":"Guidelines for anesthesia and perioperative management in elderly Chinese patients with hip fracture","volume":"97","author":"Chinese Society of Anesthesiology elderly Anesthesiology group, Chinese Society of Anesthesiology Orthopedic Anesthesiology group","year":"2017","journal-title":"Chinese medical journal"},{"key":"pone.0333909.ref019","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jclinane.2019.05.010","article-title":"Clinical predictors of postoperative delirium, functional status, and mortality in geriatric patients undergoing non-elective surgery for hip fracture","volume":"58","author":"MJ Harris","year":"2019","journal-title":"J Clin Anesth"},{"issue":"12","key":"pone.0333909.ref020","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1007\/s001980070022","article-title":"Femoral neck and intertrochanteric fractures have different risk factors: a prospective study","volume":"11","author":"KM Fox","year":"2000","journal-title":"Osteoporos Int"},{"issue":"9","key":"pone.0333909.ref021","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1007\/s00198-021-05849-y","article-title":"Current status and distribution of hip fractures among older adults in China","volume":"32","author":"XF Gong","year":"2021","journal-title":"Osteoporos Int"},{"issue":"1","key":"pone.0333909.ref022","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/TA.0000000000003358","article-title":"The interaction between pre-admission \u03b2-blocker therapy, the Revised Cardiac Risk Index, and mortality in geriatric hip fracture patients","volume":"92","author":"A Mohammad Ismail","year":"2022","journal-title":"J Trauma Acute Care Surg"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333909","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T17:30:58Z","timestamp":1760549458000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333909"}},"subtitle":[],"editor":[{"given":"Nan","family":"Jiang,","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333909","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]}}}