Impact of Comorbidities on Preoperative and Postoperative Outcomes in Hip Fracture Patients

Impact of Comorbidities on Preoperative and Postoperative Outcomes in Hip Fracture Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Comorbidities on Preoperative and Postoperative Outcomes in Hip Fracture Patients Ercan Bayar, Tolgahan Cengiz, Furkan Erdoğan, Hüseyin Sina Coşkun, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7768958/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Apr, 2026 Read the published version in BMC Geriatrics → Version 1 posted 15 You are reading this latest preprint version Abstract Background Hip fractures represent a major public health concern due to their increasing incidence in the aging population and their association with significant morbidity and mortality. Comorbidities are known to complicate both the surgical management and rehabilitation process, yet their specific impact on outcomes remains variable across studies. Objective This study aimed to determine the prevalence and distribution of comorbidities in patients who presented with hip fractures and underwent surgical treatment, to evaluate perioperative and postoperative risk factors retrospectively, and to compare these findings with the existing literature. Methods A retrospective descriptive analysis was conducted on 589 patients aged ≥ 60 years who were surgically treated for hip fractures between 2013 and 2024 at a tertiary university hospital. Demographic characteristics, surgical protocols, anesthesia types, revision rates, infection, dislocation, mobilization outcomes, hospital stay, intensive care admissions, and mortality were systematically analyzed in relation to comorbidity profiles and the number of comorbidities. Statistical analyses included chi-square, Fisher’s exact test, Mann-Whitney U, and Kruskal-Wallis tests, with p < 0.05 considered significant. Results Hypertension (59.1%), diabetes mellitus (33.6%), coronary artery disease (21.4%), and Alzheimer’s disease (21.4%) were the most frequent comorbidities. Revision surgery was significantly associated with diabetes mellitus and congestive heart failure. Diabetes mellitus, coronary artery disease, and chronic renal failure were strong predictors of postoperative infection. While the mean hospital stay was significantly prolonged in patients with ≥ 3 comorbidities, mortality was significantly associated only with oncological diseases and chronic renal failure. Contrary to expectations, no significant correlation was found between overall mortality and the number of comorbidities. Conclusion Comorbidities, particularly diabetes mellitus, congestive heart failure, oncological diseases, and chronic renal failure, substantially influence surgical outcomes, postoperative complications, and hospitalization in hip fracture patients. However, the number of comorbidities alone was not a predictor of mortality, highlighting the importance of the type rather than the quantity of comorbid conditions. These findings underscore the need for individualized perioperative planning and comprehensive patient counseling to reduce risks and improve postoperative outcomes. Hip fracture Comorbidity Mortality Postoperative complications Geriatrics Introduction With the aging of the population and the increase in life expectancy, the frequency of hip fractures is increasing in patients over 55 years of age [ 1 ]. While the number of hip fractures seen annually in the world was 1.66 million in 1990, the number of hip fractures and fracture-related surgeries is estimated to be 6.26 million in 2050 [ 2 ]. In addition to the increasing number of hip fractures, the hip fracture survivor population is likely to be older and have more comorbidities, leading to increased length of hospital stay [ 3 ]. Hip fractures exhibit a variable etiology with age. While they are associated with high-energy trauma in younger patients, hip fractures can occur in older patients from falls from the same level without high-energy trauma. These fractures are among the 10 leading causes of physical disability in adults worldwide and the second leading cause of hospitalization in the elderly population [ 4 ]. In the past, patients with femoral neck fractures were managed with skin traction or immobilization in bed. Many elderly patients died before their fractures healed due to prolonged immobilization, and those who did recover experienced numerous complications. Today, conservative treatment is no longer preferred in the elderly population due to its complications; surgery has become the gold standard. Surgical treatment options include total or hemiarthroplasty with internal or external fixation of the fracture. Hip fracture patients often have complicated comorbidities, and the rate of these patients at presentation is 60% [ 5 ]. These comorbidities, which complicate treatment and subsequent rehabilitation, not only hinder patient compliance but also weaken the body's resistance, making the patient vulnerable. Numerous studies have reported that the risk of mortality in patients undergoing surgical treatment for hip fractures increases proportionally with the number of comorbidities [ 6 , 7 ]. In this study, the primary aim was to comprehensively evaluate both the prevalence and distribution of comorbidities, as well as the number of comorbid conditions, in patients presenting to the emergency department with hip fractures who subsequently underwent surgical treatment. Furthermore, preoperative and postoperative factors were retrospectively analyzed to identify their impact on clinical outcomes. By comparing these findings with the current literature, this study provides a rare and valuable contribution, as few investigations have simultaneously addressed comorbidity burden, perioperative variables, and long-term outcomes in such a large cohort of surgically treated hip fracture patients. Material and Method This retrospective descriptive study included patients who presented to the Department of Orthopedics and Traumatology at Ondokuz Mayıs University Faculty of Medicine for hip fractures and underwent surgical treatment between 2013 and 2024. Surgical procedures included internal fixation, proximal femoral nailing, and total and partial hip arthroplasty. Traumatic hip fracture diagnosis codes were scanned from the hospital information management system to identify 896 patients. Inclusion and Exclusion Criteria Patients with full access to preoperative and postoperative clinical and radiological data, those with at least 6 months of follow-up data, and those aged 60 and over were included in the study. A total of 307 patients were excluded from the study if their preoperative and postoperative radiographs were unavailable, if their medical data were missing or deleted from the hospital automation system, if they or their first-degree relatives could not be reached despite telephone contact attempts, if their hip fractures were non-traumatic (pathological fracture, metastasis, primary bone tumor), if they had a history of previous surgery around the hip (e.g., previous hip replacement, internal fixation, osteotomy, etc.), if they had bilateral hip fractures or other concurrent major orthopedic surgery, or if follow-up follow-ups could not be conducted for any reason up to 12 months postoperatively. The study continued with the remaining 589 patients. Surgical Protocol and Postoperative Approach Surgical Protocol and Postoperative Approach The patients underwent necessary examinations and imaging studies upon presentation to the emergency department. Informed consent was obtained from the patients and their first-degree relatives for surgical treatment. Following presentation to the emergency department, patients were admitted to the Orthopedics and Traumatology wards. Preoperative preparations were made by consulting with relevant specialists and the Anesthesiology Department regarding comorbidities. First-generation cephalosporin 2 g IV was administered half an hour before surgery and continued for an average of one week postoperatively at a dose of 1 g 3 times daily until stitch removal. Following surgery, each patient was mobilized with partial or full weight-bearing, depending on the type of surgery. Mobilization was performed under the supervision of the surgical team and physiotherapists. Relevant specialist recommendations were obtained regarding the patients' comorbidities and their preparation for discharge. During postoperative follow-up, all patients were called for physical examination and radiological control on the 15th day, 1st month, 6th month, 12th month, and annually thereafter. Demographic characteristics of the patients, such as age and gender, time to surgery, postoperative intensive care follow-up, hospital stay, history of postoperative infection and revision surgery, type of anesthesia applied for surgery, postoperative 1st and 6th month mobilization levels, and mortality rates were calculated. These variables were compared with comorbidities and the number of comorbidities. Ethics The study followed the Declaration of Helsinki. The study was conducted with the approval of the Ondokuz University Clinical Research Ethics Committee (Decision no: 2024/350 Approval date: 22/10/2024). Statistical analysis Analyses were performed using SPSS version 25 (SPSS Inc., Amonk, NY, IBM Corp., USA). Descriptive statistics included mean, standard deviation, median, minimum, and maximum for continuous data, and frequency and percentage for categorical data. The Kolmogorov-Smirnov test was used to assess normality. The Mann-Whitney U test was used for pairwise comparisons where the normal distribution assumption was not met, and the Kruskal-Wallis test was used for comparisons of more than two groups. Pearson's chi-square and Fisher's exact tests were used to compare categorical data. P < 0.050 was considered significant in the interpretation of analyses. Results Of the 589 patients included in the study, 195 (33.1%) were male and 394 (66.9%) were female. Internal fixation and proximal femoral nailing were applied to 343 (58.23%) of the 589 patients, and arthroplasty surgery was performed in 246 (41.77%). The overall mean age of these patients was 78.73 ± 8.64 years. The mean age of male patients was 77.83 ± 7.56 years, while the mean age of female patients was 79.18 ± 9.10 years. Additional diseases of 589 patients were recorded from the hospital information system and e-pulse information (Table 1 ). Common diseases were grouped under their own names, while rarer diseases were grouped under the "others" group. For 589 patients: 198 (33.6%) had a diagnosis of diabetes mellitus (DM), 348 (59.1%) had a diagnosis of hypertension (HT), 126 (21.4%) had a diagnosis of coronary artery disease (CAD), 82 (13.9%) had a diagnosis of congestive heart failure (CHF), 62 (10.5%) had a diagnosis of chronic renal failure (CRF), 51 (8.7%) had a diagnosis of cerebrovascular disease (CVD), 126 (21.4%) had a diagnosis of Alzheimer's disease (ALZ), 28 (4.8%) had a diagnosis of Parkinson's disease, 5 (0.8%) had a diagnosis of epilepsy, 40 (6.8%) had a diagnosis of oncological disease, 77 (13.1%) had a diagnosis of chronic obstructive pulmonary disease (COPD), and 7 (1.2%) had a diagnosis of psychiatric disease. 60 (10.2%) patients had other diagnoses (subarachnoid hemorrhage, myopathy, systemic lupus erythematosus, pulmonary thromboembolism, pancytopenia, scleroderma, peripheral artery disease, benign prostatic hyperplasia, rheumatoid arthritis, sarcoidosis, interstitial lung disease, multiple sclerosis, idiopathic thrombocytopenic purpura, myasthenia gravis, goiter, cystic fibrosis, aplastic anemia, myelodysplastic syndrome, osteoporosis, cirrhosis). Patients were divided into four groups according to the number of additional diseases (Table 2). Table 1 Ranking of the number of comorbidities of the patients from highest to lowest. Additional Disease N (%) Total Ht 348 (59,1%) 589 (100%) Dm 198 (33,6%) 589 (100%) Cad 126 (21,4%) 589 (100%) Alz 126 (21,4%) 589 (100%) Chf 82 (13,9%) 589 (100%) Copd 77 (13,1%) 589 (100%) Crf 62 (10,5%) 589 (100%) Other 60 (10,2%) 589 (100%) Cvd 51 (8,7%) 589 (100%) Oncological 40 (6,8%) 589 (100%) Parkinson’s 28 (4,8%) 589 (100%) Psychiatric 7 (1,2%) 589 (100%) Epilepsy 5 (0,8%) 589 (100%) (HT – Hypertension; DM – Diabetes Mellitus; CAD – Coronary Artery Disease; ALZ – Alzheimer’s Disease; CHF – Congestive Heart Failure; CRF – Chronic Renal Failure; CVD – Cerebrovascular Disease; COPD – Chronic Obstructive Pulmonary Disease; ONC – Oncological Diseases.) Table-2: Classification based on the number of comorbidities No Comorbidity (1) Single comorbidity (2) Two comorbidity (3) Three or more comorbidities (4) Total N / % 44 (7,5%) 134 (22,8%) 194 (32,9%) 217 (36,8%) 589(%100) Of the 589 patients, 39 (6.6%) underwent revision surgery, while 550 (93.4%) did not. Of these 39 patients, 23 (58.97%) underwent revision surgery due to infection, 8 (20.51%) due to prosthesis dislocation, 2 (5.12%) due to implant failure, and 6 (15.3%) due to avascular necrosis of the femoral head. Comorbidities were compared individually between patients who underwent revision and those who did not. The revision rate was significantly higher in patients with DM (p = 0.003) and CHF (p = 0.014). No revisions were observed in those with CVD, and this difference was statistically significant (p = 0.039). No significant association was found between revisions and other comorbidities (p > 0.05). Regarding the reasons for revision, in a comparison of comorbidities in 246 patients who underwent prosthesis surgery with and without dislocation, a significant association was found between CHF (p = 0.002) and CRF (p = 0.040) and the risk of dislocation. The absence of dislocation in ALZ and CAD patients was statistically significant (both p = 0.019). No significant association was found between dislocation and other comorbidities (p > 0.05). The risk of dislocation was significantly increased in patients with CHF and CRF. Of these two diseases, CHF was the comorbidity that most increased the risk of dislocation. However, the absence of dislocation in CAD and ALZ patients constituted a significant difference. When examining patients with postoperative infection, postoperative infection was detected in 39 of 589 patients (6.6%). Comorbidities of patients with and without postoperative infection were compared individually. The infection rate was 14.1% in patients with DM and 2.8% in those without (p < 0.001), 11.9% in patients with CAD and 5.2% in those without (p = 0.014), and 14.5% in patients with CRF and 5.7% in those without (p = 0.015). The risk of infection was significantly higher in patients with DM, CAD, and CRF. Of these three diseases, DM was the disease that increased the risk of infection the most. Avascular necrosis of the femoral head, another reason for revision, was detected in 6 (1.7%) of 343 patients without prosthesis. No significant difference was found when comparing the comorbidities of patients with and without avascular necrosis (p > 0.05). When mortality rates in the study group were examined, the overall mortality rate was 324 (55%), while the number of surviving patients was 265 (45%). Based on these values, the 6-month mortality rate was 21.9%, the 1-year mortality rate was 32.8%, and the 5-year mortality rate was 50.3%. When mortality rates for each comorbidity were examined, a significant association between oncological diseases and mortality was found (p < 0.001). According to this result, patients diagnosed with oncological diseases had significantly higher first-year mortality rates. In those with CRF, first-6-month mortality was significantly lower (30.6%), but 1-year mortality was significantly higher (38.7%) (p = 0.015). No significant difference was found in mortality rates when comparing each of the other comorbidities. Mortality rates of patients divided into four groups based on the number of comorbidities were compared, and no significant correlation was found between them (p = 0.131). Contrary to expectations, there was no change in mortality rates as the number of comorbidities increased. When the mean and median values of the patients' time to surgery (AAS) were calculated, the mean value was 3.11 ± 2.68 days, while the median value was 2 (0–24) days. When the time to surgery of patients with each comorbidity was compared, the time to surgery was found to be significantly longer in patients diagnosed with DM (p = 0.010), HT (p = 0.001), CAD (p = 0.001) and CRF (p = 0.040) compared to those without. No significant correlation was found between other comorbidities and time to surgery (p > 0.05). In the analysis performed according to the number of comorbidities, it was observed that the time to surgery significantly prolonged as the number of diseases increased (p < 0.001). In post-hoc analysis; A significant difference was found between individuals with no additional disease and those with 3 diseases (p = 0.001), between one and three (p < 0.001) and between two and three (p < 0.001) (Table 3). Table-3: Comparison of the time to surgery and the number of comorbidities. Time to surgery / number of comorbidities No comorbidities One comorbidities Two comorbidities Three or more comorbidities Total P < 0,001 Average 2,30 ± 1,72 2,49 ± 2,07 2,97 ± 2,48 3,79 ± 3,15 3,11 ± 2,68 Median 2 (0–6) 2 (0–12) 2 (0–12) 3 (0–24) 2 (0–24) The mean hospital stay of 589 patients was 8.52 ± 5.62 days, and the median was 7 (1–61) days. When the mean and median hospital stays of patients divided into four groups based on the number of comorbidities were calculated and compared, the hospital stays of patients with 3 or more comorbidities were found to be significantly longer than those of the other groups (Table 4) (p < 0.001). Table-4: Comparison of duration of hospital stay and number of comorbidities. hospital stay / number of comorbidities No comorbidities One comorbidities Two comorbidities Three or more comorbidities Total Average 7,66 ± 4,53 7,70 ± 4,10 7,99 ± 4,79 9,66 ± 6,99 8,52 ± 5,62 Median 7 (3–30) 7 (2–40) 7 (1–53) 9 (2–61) 7 (1–61) When mobilization levels were compared individually for each comorbidity, the rate of immobilization at 6 months was significantly lower in patients with CHF (p = 0.002), while the rate of immobilization at 1 and 6 months postoperatively was significantly higher in patients with ALZ (p < 0.001). Furthermore, the rate of independent mobilization at 6 months was significantly lower in patients with cancer (p = 0.009). Comparisons of other comorbidities revealed no significant correlation between mobilization levels at 1 and 6 months postoperatively (p > 0.05). When the anesthesia methods applied to 589 patients were examined, it was seen that 245 (41.6%) patients received general anesthesia, while 344 (58.4%) patients received spinal anesthesia. When anesthesia types were compared for each comorbidity, significant associations were found between anesthesia methods and CHF (p = 0.001), CRF (p = 0.004), and psychiatric diseases (p = 0.023). While the rate of spinal anesthesia was significantly higher in patients with CHF and CRF diagnoses, the rate of general anesthesia was significantly higher in patients with psychiatric diseases. No significant association was found between other comorbidities and anesthesia types (p > 0.05). When the postoperative intensive care unit follow-up of 589 patients was examined, 243 (41.3%) patients were followed in the intensive care unit, while 346 (58.7%) were admitted to the ward without being followed in the intensive care unit. When the intensive care unit admissions of patients with each comorbidity were compared, patients with HT (p = 0.027) and CHF (p = 0.045) were found to have significantly more ICU admissions. No significant correlation was found between the ICU admissions of patients with other comorbidities (p > 0.05). When comparing the number of comorbidities with postoperative intensive care unit admissions, the need for intensive care increases significantly as the number of comorbidities increases (p = 0.001). The rate of postoperative intensive care unit admissions is particularly high among individuals with two comorbidities and those with three or more comorbidities. Discussion Comorbidities constitute a critical factor influencing both prognosis and management strategies in clinical practice. In our study, among 589 patients evaluated, the most prevalent comorbidities were hypertension in 348 patients (59.1%), diabetes mellitus in 198 patients (33.6%), and coronary artery disease in 126 patients (21.4%), with Alzheimer’s disease also detected in 126 patients (21.4%). In contrast, a study conducted between 2005 and 2013 on patients with hip fractures reported the three most common comorbidities as congestive heart failure, Alzheimer’s disease, and oncological disorders [ 8 ]. Another study found the most common comorbidities in patients with hip fractures to be ALZ, DM, and heart disease [ 9 ]. Comparing the data in the literature with the data in our study, we can say that the results are similar and that the hip fracture patients in our study are comparable to the literature in terms of comorbidities. In our study, comparing mortality with comorbidities, patients diagnosed with oncological diseases and CRF had significantly higher first-year mortality. No significant results were found in the comparison with other comorbidities. D’Angelo et al., in a study of 299 patients, compared mortality rates with comorbidities such as hypertension, chronic heart failure, chronic heart failure, neurological diseases, oncological diseases, CAD, and diabetes mellitus (DM). Similar to our study, they found a significant association between oncological diseases and mortality [ 10 ]. Another study conducted in Australia found a significant association between mortality and oncological diseases, CRF, and CHF [ 11 ]. The results of our study are consistent with the literature. Both oncological diseases and CRF themselves and their treatment increase the overall debility of patients, resulting in more complications compared to patients with other comorbidities, resulting in higher mortality. Although comorbidities are generally considered a determinant of survival, our analysis revealed no significant association between mortality and the number of comorbidities. Contrary to expectations, mortality rates did not increase as the number of comorbidities rose. In contrast, Kenzora et al. reported that patients with more than four comorbidities had higher mortality and morbidity rates compared to those with fewer than three comorbidities [ 12 ]. Kannegaard et al. reported that patients with multiple comorbidities had significantly higher mortality rates in the first year of hip fracture [ 13 ]. The results in our study contradict those in the literature. Differences in the demographic characteristics of the patients included in the study may have contributed to this discrepancy. While the number of comorbidities is an important factor, the nature of these comorbidities is also crucial. Among comorbidities, only oncological diseases and CRF were found to be significantly associated with mortality. This is explained by older age and the higher mortality rates in patients with these diagnoses, even without a fracture. When revision and comorbidities were compared, a significant association was found between revision surgery and comorbidities such as DM and CHF. According to this result, revision surgery rates are significantly higher in patients with DM and CHF. Tsai et al., in their study comparing revision surgery rates with comorbidities, found significant associations between psychiatric disorders and CHF, but not with DM [ 14 ]. In our study, the higher revision rates in patients with DM were attributed to the higher incidence of infection in these patients. This may be explained by the wound healing problems frequently observed in DM patients. Regarding the reasons for revision, when comparing postoperative infection with comorbidities, the risk of infection was significantly higher in patients diagnosed with diabetes mellitus (DM), CAD, and CRF. Of these three diseases, DM was found to increase the risk of infection the most. No significant association was found between other comorbidities and infection. Duckworth et al. found a significantly higher risk of infection in patients diagnosed with ALZ and DM [ 15 ]. There are other studies in the literature that found a significantly higher rate of postoperative infection in patients with DM and cardiological disease [ 16 , 17 ]. Acklin et al. reported that the highest association with infection was between ALZ, DM diagnoses and Staphylococcus aureus infections [ 18 ]. Our study supports the literature. We believe it is crucial to inform patients with DM about the risk of infection before surgery and obtain detailed written informed consent. When dislocation, another reason for revision, was compared with comorbidities, particularly in patients with prosthetic replacement surgery, a significant association was found between dislocation and the diagnosis of CHF and CRF. The absence of dislocation in patients with ALZ and CAD was statistically significant. No significant associations were found between other comorbidities and dislocation. The risk of dislocation was significantly increased in patients with CHF and CRF. In a review of the literature, Salem et al. found no significant difference in the comparison of dislocation and comorbidities [ 19 ]. In another study comparing dislocation with additional diseases, especially neurological diseases such as ALZ, Parkinson's disease, CVD, etc., no significant relationship was found between dislocation and neurological diseases [ 20 ]. Our study also found significantly higher rates of immobilization in patients with neurological disorders, particularly those diagnosed with ALZ. The lower incidence of dislocations was attributed to the lower active mobility in these patients. While there are both supporting and contradicting findings in the literature, there is no clear consensus. Further research is needed on this topic. When comparing postoperative mobilization at 1 month and 6 months with comorbidities, the level of immobilization was found to be significantly higher in patients with ALZ at 1 and 6 months postoperatively. Furthermore, the 6-month immobilization rate was significantly lower in patients with CHF. No significant correlation was found between postoperative mobilization levels at 1 and 6 months when comparing each of the other comorbidities. Patients with ALZ require excellent home care. Given that many of these patients live alone or with their elderly spouses, it is expected that they do not achieve adequate mobilization levels. Gialanella et al. reported significantly lower postoperative mobilization levels and functional outcomes in patients with ALZ who underwent surgical treatment after hip fractures [ 21 ]. Walking problems can occur in patients with ALZ even without a hip fracture, and these problems worsen with a hip fracture. Some studies in the literature, as well as the results of our study, indicate that patients with ALZ experience difficulty regaining their mobility after surgery. Given this finding, it would be appropriate to inform patients with ALZ and their families about the risk of ambulation following a hip fracture and the need for additional caregiver support in the first few months. The analysis revealed that patients with diabetes mellitus, hypertension, coronary artery disease, and chronic renal failure experienced a significantly longer time to surgery compared to those without these conditions. Considering these diagnoses, the following factors are important: ensuring blood sugar regulation in patients with DM, ensuring blood pressure control in patients with HT to ensure suitability for surgery, the need for a waiting period for surgery after discontinuing antithrombotic agents in patients with CAD, ensuring renal function and urine output in patients with CRF are suitable for surgery, managing laboratory values with hemodialysis if necessary, and all the necessary tests and treatments, including consultations with relevant departments. Furthermore, when comparing the time to surgery with the number of comorbidities in our study, the waiting time for surgery increased significantly as the number of comorbidities increased. A similar study reported that patients with three or more comorbidities waited longer for surgery and had longer hospital stays [ 22 ]. There are also different studies in the literature reporting that the time to surgery increases as the number of additional diseases increases. [ 23 ]. As the number of comorbidities increases, the number of additional preoperative consultations required increases, as reported in the literature, and these consultations prolong the time it takes for the patient to be ready for surgery. Consequently, patients spend longer in the hospital. This makes patients more susceptible to hospital-acquired infections, so planning the surgical team to shorten the preoperative period as much as possible will reduce mortality and complication rates. In our study, when hospital stay was compared with the number of comorbidities, patients with three or more comorbidities had significantly longer hospital stays than the other groups. Zuckerman et al. reported that both the waiting time for surgery and the length of hospital stay increased as the number of comorbidities increased [ 23 ]. In another study where the number of comorbidities was grouped as no comorbidity, 1 or 2 comorbidities, and 3 or more comorbidities, it was found that patients with 3 or more comorbidities had longer hospital stays [ 22 ]. Considering that the wait time for surgery increases with the number of comorbidities, it is expected that patients with three or more comorbidities will have longer hospital stays. Similar results are also found in the literature. When anesthesia methods used during surgery were compared with comorbidities, significant associations were found between the type of anesthesia and CHF, CRF, and psychiatric disorders. Spinal anesthesia rates were significantly higher in patients with CHF and CRF, while general anesthesia rates were significantly higher in patients with psychiatric disorders. No significant associations were found between other comorbidities and anesthesia types. Some studies have found that general anesthesia worsens systemic diseases, particularly cardiological diseases, renal diseases, and pulmonary diseases, and causes more complications compared to spinal anesthesia [ 24 , 25 ]. To reduce these complications, it would be more appropriate to administer spinal anesthesia rather than general anesthesia to patients with these conditions, if possible. A similar result was found in our study. Patients with psychiatric illnesses may be anxious about spinal anesthesia. Vermersch et al. recommended general anesthesia for conditions such as delirium, anxiety, and agitation in psychiatric patients [ 26 ]. McAllister et al. stated that needle injection phobia in psychiatric patients increases anxiety and makes spinal anesthesia difficult, and therefore, these patients should be given general anesthesia [ 27 ]. In our study, general anesthesia was applied significantly more frequently to patients diagnosed with psychiatric illness, and this result is consistent with the recommendations in the literature. Patients diagnosed with HT and CHF exhibited a markedly higher rate of postoperative intensive care unit admissions compared to those without these conditions. A similar study in the literature linked intensive care unit admissions to HT, CHF, and CVD, but reported no association between ICU admissions and other conditions, such as DM, CRF [ 28 ]. Courtney et al. reported that patients with CHF were followed in the intensive care unit significantly more often [ 29 ]. The results of our study and the literature support each other. The need for intensive care monitoring depends on many factors. One of these factors is the presence of additional comorbidities. These patients may require intensive care monitoring due to both the fracture and these comorbidities. These patients and their families should be informed that they may be admitted to intensive care before surgery, and the intensive care team should be informed in advance. Conclusion Comorbidities are one of the main determinants of mortality and morbidity after surgical treatment in hip fracture patients. The presence of comorbidities is a significant factor negatively impacting the treatment process. It is crucial to prepare detailed consent forms for hip fracture patients and their families regarding the increased risk factors these comorbidities may pose during and after treatment, and to obtain their consent to avoid legal issues. In light of the results of this study, dislocation rates in patients with CRF and CHF are higher; infection and consequently revision surgery rates, especially in patients with DM; mortality rates in the first year are higher in patients with oncological diseases; immobilization problems are common in patients with ALZ; and patients with CHF and HT require more intensive care after surgery. Effective and prompt surgical teams, aware of the potential risks, who treat elderly patients with hip fractures will reduce mortality and morbidity rates. Declarations Disclosures: All authors have nothing to disclose Funding: The authors received no financial support for this article's research, authorship, and/or publication. Conflicts of interest/Competing interests : The authors have no relevant financial or non-financial interests to disclose. Availability of data and material: The data supporting this study's findings are available from the corresponding author upon request. Ethics approval : The study followed the Declaration of Helsinki. The study was conducted with the approval of the Ondokuz University Clinical Research Ethics Committee (Decision no: 2024/350 Approval date: 22/10/2024). The study followed the Declaration of Helsinki. Human Ethics and Consent to Participate Declarations : All participants gave written informed consent. Consent for publication : Not Applicable. Informed Consent Statement: All participants gave written informed consent. Clinical trial number: Not applicable. Author Contributions: Conception and design of the work, supervision, and manuscript drafting: E.B., Y.T.; Data collection, analysis, and interpretation of the data: E.B., T.C., F.E., H.S.C.; Statistical analysis: E.B.; Critical manuscript revision: all authors. Approval of the final manuscript: all authors. References Lin FF, et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails. 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Sierra RJ, Schleck CD, Cabanela ME. Dislocation of bipolar hemiarthroplasty: rate, contributing factors, and outcome. Clin Orthop Relat Research®. 2006;442:230–8. Gialanella B, et al. Determinants of functional outcome in hip fracture: the role of comorbidity. Aging Clin Exp Res. 2018;30:643–50. Lefaivre K, et al. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br Volume. 2009;91(7):922–7. Zuckerman JD, et al. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. JBJS. 1995;77(10):1551–6. Beaupre LA, et al. Best practices for elderly hip fracture patients: a systematic overview of the evidence. J Gen Intern Med. 2005;20:1019–25. Rodgers A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493. Vermersch C et al. Cesarean section and sismotherapy in a severe psychotic parturient: a case report . in Annales Francaises D'anesthesie et de Reanimation . 2013. McAllister N, et al. Pregnancy outcomes in women with severe needle phobia. Eur J Obstet Gynecol Reproductive Biology. 2012;162(2):149–52. MİNİKSAR Ö, et al. Intensive Care Unit Admission Predictors of Geriatric Patients Who Underwent Hemiarthroplasty due to Hip Fracture. Volume 12. JOURNAL OF CRITICAL & INTENSIVE CARE; 2021. 1. Courtney P, et al. Which patients need critical care intervention after total joint arthroplasty? a prospective study of factors associated with the need for intensive care following surgery. Bone Joint J. 2015;97(11):1512–8. Additional Declarations No competing interests reported. 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Bayar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBCDBChtA8SMjQdI0ZIG0tJAkpbDYBKvFn7pww8/F+64k8c/I/nZ58o95+3Wth8G2lJjE41Li2RfmrH0zDPPiiVupBkD6dvJ284kArUcS8ttwKHF4AwPgzRv2+HEhhsJxkBP3E42OwDUwthwGKcW+zM8zL9BWubfSP8M1HIu2ez8Q/xaDHh42MC2bLiRA7LlgJ3ZDQK2SJxhM7MGaik2PPOmGKglOcHsBtCWBDx+4e9hfnwbqCVP7nj6ZqAWO3uz8+kPH3yoscGpBQEEEsBUIlhlAkHlYPsOgCl7ohSPglEwCkbBiAIAWOVmNTN2yTMAAAAASUVORK5CYII=","orcid":"","institution":"Tosya State Hospital Clinic of Orthopedics and Traumatology","correspondingAuthor":true,"prefix":"","firstName":"Ercan","middleName":"","lastName":"Bayar","suffix":""},{"id":547082388,"identity":"34edb90a-05aa-4a66-b9cc-0f8ec3e8b083","order_by":1,"name":"Tolgahan Cengiz","email":"","orcid":"","institution":"Fatsa State 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20:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7768958/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7768958/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-026-07441-7","type":"published","date":"2026-04-18T15:59:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":96279896,"identity":"b4bd9da9-da6c-4e53-ba84-acb9183703ba","added_by":"auto","created_at":"2025-11-19 10:58:28","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70989,"visible":true,"origin":"","legend":"","description":"","filename":"ImpactofComorbiditiesonPreoperativeandPostoperativeOutcomesinHipFracturePatients.docx","url":"https://assets-eu.researchsquare.com/files/rs-7768958/v1/dd862532a6cc8a0cc0d64ba4.docx"},{"id":96364622,"identity":"c389cfa4-c800-41f6-998a-ea3622519219","added_by":"auto","created_at":"2025-11-20 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10:09:15","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101455,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7768958/v1/e7c763c6778e9a03ca5df682.html"},{"id":107350813,"identity":"319c6c41-899c-497e-9af2-3740ebc38718","added_by":"auto","created_at":"2026-04-20 16:05:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":382966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7768958/v1/7a6177ac-59db-4412-947c-3aadd183a7dd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Comorbidities on Preoperative and Postoperative Outcomes in Hip Fracture Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the aging of the population and the increase in life expectancy, the frequency of hip fractures is increasing in patients over 55 years of age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While the number of hip fractures seen annually in the world was 1.66\u0026nbsp;million in 1990, the number of hip fractures and fracture-related surgeries is estimated to be 6.26\u0026nbsp;million in 2050 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In addition to the increasing number of hip fractures, the hip fracture survivor population is likely to be older and have more comorbidities, leading to increased length of hospital stay [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHip fractures exhibit a variable etiology with age. While they are associated with high-energy trauma in younger patients, hip fractures can occur in older patients from falls from the same level without high-energy trauma. These fractures are among the 10 leading causes of physical disability in adults worldwide and the second leading cause of hospitalization in the elderly population [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the past, patients with femoral neck fractures were managed with skin traction or immobilization in bed. Many elderly patients died before their fractures healed due to prolonged immobilization, and those who did recover experienced numerous complications. Today, conservative treatment is no longer preferred in the elderly population due to its complications; surgery has become the gold standard. Surgical treatment options include total or hemiarthroplasty with internal or external fixation of the fracture.\u003c/p\u003e\u003cp\u003eHip fracture patients often have complicated comorbidities, and the rate of these patients at presentation is 60% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These comorbidities, which complicate treatment and subsequent rehabilitation, not only hinder patient compliance but also weaken the body's resistance, making the patient vulnerable. Numerous studies have reported that the risk of mortality in patients undergoing surgical treatment for hip fractures increases proportionally with the number of comorbidities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, the primary aim was to comprehensively evaluate both the prevalence and distribution of comorbidities, as well as the number of comorbid conditions, in patients presenting to the emergency department with hip fractures who subsequently underwent surgical treatment. Furthermore, preoperative and postoperative factors were retrospectively analyzed to identify their impact on clinical outcomes. By comparing these findings with the current literature, this study provides a rare and valuable contribution, as few investigations have simultaneously addressed comorbidity burden, perioperative variables, and long-term outcomes in such a large cohort of surgically treated hip fracture patients.\u003c/p\u003e"},{"header":"Material and Method","content":"\u003cp\u003eThis retrospective descriptive study included patients who presented to the Department of Orthopedics and Traumatology at Ondokuz Mayıs University Faculty of Medicine for hip fractures and underwent surgical treatment between 2013 and 2024. Surgical procedures included internal fixation, proximal femoral nailing, and total and partial hip arthroplasty. Traumatic hip fracture diagnosis codes were scanned from the hospital information management system to identify 896 patients.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e\u003cp\u003ePatients with full access to preoperative and postoperative clinical and radiological data, those with at least 6 months of follow-up data, and those aged 60 and over were included in the study. A total of 307 patients were excluded from the study if their preoperative and postoperative radiographs were unavailable, if their medical data were missing or deleted from the hospital automation system, if they or their first-degree relatives could not be reached despite telephone contact attempts, if their hip fractures were non-traumatic (pathological fracture, metastasis, primary bone tumor), if they had a history of previous surgery around the hip (e.g., previous hip replacement, internal fixation, osteotomy, etc.), if they had bilateral hip fractures or other concurrent major orthopedic surgery, or if follow-up follow-ups could not be conducted for any reason up to 12 months postoperatively. The study continued with the remaining 589 patients.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSurgical Protocol and Postoperative Approach\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eSurgical Protocol and Postoperative Approach\u003c/div\u003e\u003cp\u003eThe patients underwent necessary examinations and imaging studies upon presentation to the emergency department. Informed consent was obtained from the patients and their first-degree relatives for surgical treatment. Following presentation to the emergency department, patients were admitted to the Orthopedics and Traumatology wards. Preoperative preparations were made by consulting with relevant specialists and the Anesthesiology Department regarding comorbidities. First-generation cephalosporin 2 g IV was administered half an hour before surgery and continued for an average of one week postoperatively at a dose of 1 g 3 times daily until stitch removal. Following surgery, each patient was mobilized with partial or full weight-bearing, depending on the type of surgery. Mobilization was performed under the supervision of the surgical team and physiotherapists. Relevant specialist recommendations were obtained regarding the patients' comorbidities and their preparation for discharge. During postoperative follow-up, all patients were called for physical examination and radiological control on the 15th day, 1st month, 6th month, 12th month, and annually thereafter.\u003c/p\u003e\u003cp\u003eDemographic characteristics of the patients, such as age and gender, time to surgery, postoperative intensive care follow-up, hospital stay, history of postoperative infection and revision surgery, type of anesthesia applied for surgery, postoperative 1st and 6th month mobilization levels, and mortality rates were calculated. These variables were compared with comorbidities and the number of comorbidities.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003eThe study followed the Declaration of Helsinki. The study was conducted with the approval of the Ondokuz University Clinical Research Ethics Committee (Decision no: 2024/350 Approval date: 22/10/2024).\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAnalyses were performed using SPSS version 25 (SPSS Inc., Amonk, NY, IBM Corp., USA). Descriptive statistics included mean, standard deviation, median, minimum, and maximum for continuous data, and frequency and percentage for categorical data. The Kolmogorov-Smirnov test was used to assess normality. The Mann-Whitney U test was used for pairwise comparisons where the normal distribution assumption was not met, and the Kruskal-Wallis test was used for comparisons of more than two groups. Pearson's chi-square and Fisher's exact tests were used to compare categorical data. P\u0026thinsp;\u0026lt;\u0026thinsp;0.050 was considered significant in the interpretation of analyses.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 589 patients included in the study, 195 (33.1%) were male and 394 (66.9%) were female. Internal fixation and proximal femoral nailing were applied to 343 (58.23%) of the 589 patients, and arthroplasty surgery was performed in 246 (41.77%). The overall mean age of these patients was 78.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.64 years. The mean age of male patients was 77.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56 years, while the mean age of female patients was 79.18\u0026thinsp;\u0026plusmn;\u0026thinsp;9.10 years.\u003c/p\u003e\u003cp\u003eAdditional diseases of 589 patients were recorded from the hospital information system and e-pulse information (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Common diseases were grouped under their own names, while rarer diseases were grouped under the \"others\" group. For 589 patients: 198 (33.6%) had a diagnosis of diabetes mellitus (DM), 348 (59.1%) had a diagnosis of hypertension (HT), 126 (21.4%) had a diagnosis of coronary artery disease (CAD), 82 (13.9%) had a diagnosis of congestive heart failure (CHF), 62 (10.5%) had a diagnosis of chronic renal failure (CRF), 51 (8.7%) had a diagnosis of cerebrovascular disease (CVD), 126 (21.4%) had a diagnosis of Alzheimer's disease (ALZ), 28 (4.8%) had a diagnosis of Parkinson's disease, 5 (0.8%) had a diagnosis of epilepsy, 40 (6.8%) had a diagnosis of oncological disease, 77 (13.1%) had a diagnosis of chronic obstructive pulmonary disease (COPD), and 7 (1.2%) had a diagnosis of psychiatric disease. 60 (10.2%) patients had other diagnoses (subarachnoid hemorrhage, myopathy, systemic lupus erythematosus, pulmonary thromboembolism, pancytopenia, scleroderma, peripheral artery disease, benign prostatic hyperplasia, rheumatoid arthritis, sarcoidosis, interstitial lung disease, multiple sclerosis, idiopathic thrombocytopenic purpura, myasthenia gravis, goiter, cystic fibrosis, aplastic anemia, myelodysplastic syndrome, osteoporosis, cirrhosis). Patients were divided into four groups according to the number of additional diseases (Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRanking of the number of comorbidities of the patients from highest to lowest.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdditional Disease\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e348 (59,1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e198 (33,6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126 (21,4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlz\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126 (21,4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (13,9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCopd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (13,1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCrf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (10,5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (10,2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCvd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (8,7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOncological\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (6,8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParkinson\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (4,8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychiatric\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (1,2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEpilepsy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (0,8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e(HT \u0026ndash; Hypertension; DM \u0026ndash; Diabetes Mellitus; CAD \u0026ndash; Coronary Artery Disease; ALZ \u0026ndash; Alzheimer\u0026rsquo;s Disease; CHF \u0026ndash; Congestive Heart Failure; CRF \u0026ndash; Chronic Renal Failure; CVD \u0026ndash; Cerebrovascular Disease; COPD \u0026ndash; Chronic Obstructive Pulmonary Disease; ONC \u0026ndash; Oncological Diseases.)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable-2: Classification based on the number of comorbidities\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo Comorbidity (1)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSingle comorbidity (2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTwo comorbidity (3)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThree or more comorbidities (4)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN / %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (7,5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134 (22,8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e194 (32,9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e217 (36,8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e589(%100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOf the 589 patients, 39 (6.6%) underwent revision surgery, while 550 (93.4%) did not. Of these 39 patients, 23 (58.97%) underwent revision surgery due to infection, 8 (20.51%) due to prosthesis dislocation, 2 (5.12%) due to implant failure, and 6 (15.3%) due to avascular necrosis of the femoral head. Comorbidities were compared individually between patients who underwent revision and those who did not. The revision rate was significantly higher in patients with DM (p\u0026thinsp;=\u0026thinsp;0.003) and CHF (p\u0026thinsp;=\u0026thinsp;0.014). No revisions were observed in those with CVD, and this difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.039). No significant association was found between revisions and other comorbidities (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Regarding the reasons for revision, in a comparison of comorbidities in 246 patients who underwent prosthesis surgery with and without dislocation, a significant association was found between CHF (p\u0026thinsp;=\u0026thinsp;0.002) and CRF (p\u0026thinsp;=\u0026thinsp;0.040) and the risk of dislocation. The absence of dislocation in ALZ and CAD patients was statistically significant (both p\u0026thinsp;=\u0026thinsp;0.019). No significant association was found between dislocation and other comorbidities (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The risk of dislocation was significantly increased in patients with CHF and CRF. Of these two diseases, CHF was the comorbidity that most increased the risk of dislocation. However, the absence of dislocation in CAD and ALZ patients constituted a significant difference. When examining patients with postoperative infection, postoperative infection was detected in 39 of 589 patients (6.6%). Comorbidities of patients with and without postoperative infection were compared individually. The infection rate was 14.1% in patients with DM and 2.8% in those without (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 11.9% in patients with CAD and 5.2% in those without (p\u0026thinsp;=\u0026thinsp;0.014), and 14.5% in patients with CRF and 5.7% in those without (p\u0026thinsp;=\u0026thinsp;0.015). The risk of infection was significantly higher in patients with DM, CAD, and CRF. Of these three diseases, DM was the disease that increased the risk of infection the most. Avascular necrosis of the femoral head, another reason for revision, was detected in 6 (1.7%) of 343 patients without prosthesis. No significant difference was found when comparing the comorbidities of patients with and without avascular necrosis (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eWhen mortality rates in the study group were examined, the overall mortality rate was 324 (55%), while the number of surviving patients was 265 (45%). Based on these values, the 6-month mortality rate was 21.9%, the 1-year mortality rate was 32.8%, and the 5-year mortality rate was 50.3%. When mortality rates for each comorbidity were examined, a significant association between oncological diseases and mortality was found (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). According to this result, patients diagnosed with oncological diseases had significantly higher first-year mortality rates. In those with CRF, first-6-month mortality was significantly lower (30.6%), but 1-year mortality was significantly higher (38.7%) (p\u0026thinsp;=\u0026thinsp;0.015). No significant difference was found in mortality rates when comparing each of the other comorbidities. Mortality rates of patients divided into four groups based on the number of comorbidities were compared, and no significant correlation was found between them (p\u0026thinsp;=\u0026thinsp;0.131). Contrary to expectations, there was no change in mortality rates as the number of comorbidities increased.\u003c/p\u003e\u003cp\u003eWhen the mean and median values of the patients' time to surgery (AAS) were calculated, the mean value was 3.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68 days, while the median value was 2 (0\u0026ndash;24) days. When the time to surgery of patients with each comorbidity was compared, the time to surgery was found to be significantly longer in patients diagnosed with DM (p\u0026thinsp;=\u0026thinsp;0.010), HT (p\u0026thinsp;=\u0026thinsp;0.001), CAD (p\u0026thinsp;=\u0026thinsp;0.001) and CRF (p\u0026thinsp;=\u0026thinsp;0.040) compared to those without. No significant correlation was found between other comorbidities and time to surgery (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the analysis performed according to the number of comorbidities, it was observed that the time to surgery significantly prolonged as the number of diseases increased (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In post-hoc analysis; A significant difference was found between individuals with no additional disease and those with 3 diseases (p\u0026thinsp;=\u0026thinsp;0.001), between one and three (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and between two and three (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;3).\u003c/p\u003e\u003cp\u003eTable-3: Comparison of the time to surgery and the number of comorbidities.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to surgery / number of comorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo comorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOne comorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTwo comorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThree or more comorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eP\u003c/p\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,30\u0026thinsp;\u0026plusmn;\u0026thinsp;1,72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,49\u0026thinsp;\u0026plusmn;\u0026thinsp;2,07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,97\u0026thinsp;\u0026plusmn;\u0026thinsp;2,48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3,79\u0026thinsp;\u0026plusmn;\u0026thinsp;3,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,11\u0026thinsp;\u0026plusmn;\u0026thinsp;2,68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0\u0026ndash;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (0\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (0\u0026ndash;24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (0\u0026ndash;24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean hospital stay of 589 patients was 8.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62 days, and the median was 7 (1\u0026ndash;61) days. When the mean and median hospital stays of patients divided into four groups based on the number of comorbidities were calculated and compared, the hospital stays of patients with 3 or more comorbidities were found to be significantly longer than those of the other groups (Table\u0026nbsp;4) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eTable-4: Comparison of duration of hospital stay and number of comorbidities.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ehospital stay / number of comorbidities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo comorbidities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOne comorbidities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTwo comorbidities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThree or more comorbidities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7,66\u0026thinsp;\u0026plusmn;\u0026thinsp;4,53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,70\u0026thinsp;\u0026plusmn;\u0026thinsp;4,10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7,99\u0026thinsp;\u0026plusmn;\u0026thinsp;4,79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9,66\u0026thinsp;\u0026plusmn;\u0026thinsp;6,99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8,52\u0026thinsp;\u0026plusmn;\u0026thinsp;5,62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (3\u0026ndash;30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (2\u0026ndash;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (1\u0026ndash;53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (2\u0026ndash;61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (1\u0026ndash;61)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen mobilization levels were compared individually for each comorbidity, the rate of immobilization at 6 months was significantly lower in patients with CHF (p\u0026thinsp;=\u0026thinsp;0.002), while the rate of immobilization at 1 and 6 months postoperatively was significantly higher in patients with ALZ (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the rate of independent mobilization at 6 months was significantly lower in patients with cancer (p\u0026thinsp;=\u0026thinsp;0.009). Comparisons of other comorbidities revealed no significant correlation between mobilization levels at 1 and 6 months postoperatively (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eWhen the anesthesia methods applied to 589 patients were examined, it was seen that 245 (41.6%) patients received general anesthesia, while 344 (58.4%) patients received spinal anesthesia. When anesthesia types were compared for each comorbidity, significant associations were found between anesthesia methods and CHF (p\u0026thinsp;=\u0026thinsp;0.001), CRF (p\u0026thinsp;=\u0026thinsp;0.004), and psychiatric diseases (p\u0026thinsp;=\u0026thinsp;0.023). While the rate of spinal anesthesia was significantly higher in patients with CHF and CRF diagnoses, the rate of general anesthesia was significantly higher in patients with psychiatric diseases. No significant association was found between other comorbidities and anesthesia types (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eWhen the postoperative intensive care unit follow-up of 589 patients was examined, 243 (41.3%) patients were followed in the intensive care unit, while 346 (58.7%) were admitted to the ward without being followed in the intensive care unit. When the intensive care unit admissions of patients with each comorbidity were compared, patients with HT (p\u0026thinsp;=\u0026thinsp;0.027) and CHF (p\u0026thinsp;=\u0026thinsp;0.045) were found to have significantly more ICU admissions. No significant correlation was found between the ICU admissions of patients with other comorbidities (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eWhen comparing the number of comorbidities with postoperative intensive care unit admissions, the need for intensive care increases significantly as the number of comorbidities increases (p\u0026thinsp;=\u0026thinsp;0.001). The rate of postoperative intensive care unit admissions is particularly high among individuals with two comorbidities and those with three or more comorbidities.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eComorbidities constitute a critical factor influencing both prognosis and management strategies in clinical practice. In our study, among 589 patients evaluated, the most prevalent comorbidities were hypertension in 348 patients (59.1%), diabetes mellitus in 198 patients (33.6%), and coronary artery disease in 126 patients (21.4%), with Alzheimer\u0026rsquo;s disease also detected in 126 patients (21.4%). In contrast, a study conducted between 2005 and 2013 on patients with hip fractures reported the three most common comorbidities as congestive heart failure, Alzheimer\u0026rsquo;s disease, and oncological disorders [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another study found the most common comorbidities in patients with hip fractures to be ALZ, DM, and heart disease [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Comparing the data in the literature with the data in our study, we can say that the results are similar and that the hip fracture patients in our study are comparable to the literature in terms of comorbidities.\u003c/p\u003e\u003cp\u003eIn our study, comparing mortality with comorbidities, patients diagnosed with oncological diseases and CRF had significantly higher first-year mortality. No significant results were found in the comparison with other comorbidities. D\u0026rsquo;Angelo et al., in a study of 299 patients, compared mortality rates with comorbidities such as hypertension, chronic heart failure, chronic heart failure, neurological diseases, oncological diseases, CAD, and diabetes mellitus (DM). Similar to our study, they found a significant association between oncological diseases and mortality [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Another study conducted in Australia found a significant association between mortality and oncological diseases, CRF, and CHF [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The results of our study are consistent with the literature. Both oncological diseases and CRF themselves and their treatment increase the overall debility of patients, resulting in more complications compared to patients with other comorbidities, resulting in higher mortality.\u003c/p\u003e\u003cp\u003eAlthough comorbidities are generally considered a determinant of survival, our analysis revealed no significant association between mortality and the number of comorbidities. Contrary to expectations, mortality rates did not increase as the number of comorbidities rose. In contrast, Kenzora et al. reported that patients with more than four comorbidities had higher mortality and morbidity rates compared to those with fewer than three comorbidities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Kannegaard et al. reported that patients with multiple comorbidities had significantly higher mortality rates in the first year of hip fracture [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The results in our study contradict those in the literature. Differences in the demographic characteristics of the patients included in the study may have contributed to this discrepancy. While the number of comorbidities is an important factor, the nature of these comorbidities is also crucial. Among comorbidities, only oncological diseases and CRF were found to be significantly associated with mortality. This is explained by older age and the higher mortality rates in patients with these diagnoses, even without a fracture.\u003c/p\u003e\u003cp\u003eWhen revision and comorbidities were compared, a significant association was found between revision surgery and comorbidities such as DM and CHF. According to this result, revision surgery rates are significantly higher in patients with DM and CHF. Tsai et al., in their study comparing revision surgery rates with comorbidities, found significant associations between psychiatric disorders and CHF, but not with DM [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In our study, the higher revision rates in patients with DM were attributed to the higher incidence of infection in these patients. This may be explained by the wound healing problems frequently observed in DM patients.\u003c/p\u003e\u003cp\u003eRegarding the reasons for revision, when comparing postoperative infection with comorbidities, the risk of infection was significantly higher in patients diagnosed with diabetes mellitus (DM), CAD, and CRF. Of these three diseases, DM was found to increase the risk of infection the most. No significant association was found between other comorbidities and infection. Duckworth et al. found a significantly higher risk of infection in patients diagnosed with ALZ and DM [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. There are other studies in the literature that found a significantly higher rate of postoperative infection in patients with DM and cardiological disease [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Acklin et al. reported that the highest association with infection was between ALZ, DM diagnoses and Staphylococcus aureus infections [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Our study supports the literature. We believe it is crucial to inform patients with DM about the risk of infection before surgery and obtain detailed written informed consent. When dislocation, another reason for revision, was compared with comorbidities, particularly in patients with prosthetic replacement surgery, a significant association was found between dislocation and the diagnosis of CHF and CRF. The absence of dislocation in patients with ALZ and CAD was statistically significant. No significant associations were found between other comorbidities and dislocation. The risk of dislocation was significantly increased in patients with CHF and CRF. In a review of the literature, Salem et al. found no significant difference in the comparison of dislocation and comorbidities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In another study comparing dislocation with additional diseases, especially neurological diseases such as ALZ, Parkinson's disease, CVD, etc., no significant relationship was found between dislocation and neurological diseases [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our study also found significantly higher rates of immobilization in patients with neurological disorders, particularly those diagnosed with ALZ. The lower incidence of dislocations was attributed to the lower active mobility in these patients. While there are both supporting and contradicting findings in the literature, there is no clear consensus. Further research is needed on this topic.\u003c/p\u003e\u003cp\u003eWhen comparing postoperative mobilization at 1 month and 6 months with comorbidities, the level of immobilization was found to be significantly higher in patients with ALZ at 1 and 6 months postoperatively. Furthermore, the 6-month immobilization rate was significantly lower in patients with CHF. No significant correlation was found between postoperative mobilization levels at 1 and 6 months when comparing each of the other comorbidities. Patients with ALZ require excellent home care. Given that many of these patients live alone or with their elderly spouses, it is expected that they do not achieve adequate mobilization levels. Gialanella et al. reported significantly lower postoperative mobilization levels and functional outcomes in patients with ALZ who underwent surgical treatment after hip fractures [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Walking problems can occur in patients with ALZ even without a hip fracture, and these problems worsen with a hip fracture. Some studies in the literature, as well as the results of our study, indicate that patients with ALZ experience difficulty regaining their mobility after surgery. Given this finding, it would be appropriate to inform patients with ALZ and their families about the risk of ambulation following a hip fracture and the need for additional caregiver support in the first few months.\u003c/p\u003e\u003cp\u003eThe analysis revealed that patients with diabetes mellitus, hypertension, coronary artery disease, and chronic renal failure experienced a significantly longer time to surgery compared to those without these conditions. Considering these diagnoses, the following factors are important: ensuring blood sugar regulation in patients with DM, ensuring blood pressure control in patients with HT to ensure suitability for surgery, the need for a waiting period for surgery after discontinuing antithrombotic agents in patients with CAD, ensuring renal function and urine output in patients with CRF are suitable for surgery, managing laboratory values with hemodialysis if necessary, and all the necessary tests and treatments, including consultations with relevant departments. Furthermore, when comparing the time to surgery with the number of comorbidities in our study, the waiting time for surgery increased significantly as the number of comorbidities increased. A similar study reported that patients with three or more comorbidities waited longer for surgery and had longer hospital stays [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. There are also different studies in the literature reporting that the time to surgery increases as the number of additional diseases increases. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. As the number of comorbidities increases, the number of additional preoperative consultations required increases, as reported in the literature, and these consultations prolong the time it takes for the patient to be ready for surgery. Consequently, patients spend longer in the hospital. This makes patients more susceptible to hospital-acquired infections, so planning the surgical team to shorten the preoperative period as much as possible will reduce mortality and complication rates.\u003c/p\u003e\u003cp\u003eIn our study, when hospital stay was compared with the number of comorbidities, patients with three or more comorbidities had significantly longer hospital stays than the other groups. Zuckerman et al. reported that both the waiting time for surgery and the length of hospital stay increased as the number of comorbidities increased [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In another study where the number of comorbidities was grouped as no comorbidity, 1 or 2 comorbidities, and 3 or more comorbidities, it was found that patients with 3 or more comorbidities had longer hospital stays [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Considering that the wait time for surgery increases with the number of comorbidities, it is expected that patients with three or more comorbidities will have longer hospital stays. Similar results are also found in the literature.\u003c/p\u003e\u003cp\u003eWhen anesthesia methods used during surgery were compared with comorbidities, significant associations were found between the type of anesthesia and CHF, CRF, and psychiatric disorders. Spinal anesthesia rates were significantly higher in patients with CHF and CRF, while general anesthesia rates were significantly higher in patients with psychiatric disorders. No significant associations were found between other comorbidities and anesthesia types. Some studies have found that general anesthesia worsens systemic diseases, particularly cardiological diseases, renal diseases, and pulmonary diseases, and causes more complications compared to spinal anesthesia [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. To reduce these complications, it would be more appropriate to administer spinal anesthesia rather than general anesthesia to patients with these conditions, if possible. A similar result was found in our study. Patients with psychiatric illnesses may be anxious about spinal anesthesia. Vermersch et al. recommended general anesthesia for conditions such as delirium, anxiety, and agitation in psychiatric patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. McAllister et al. stated that needle injection phobia in psychiatric patients increases anxiety and makes spinal anesthesia difficult, and therefore, these patients should be given general anesthesia [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In our study, general anesthesia was applied significantly more frequently to patients diagnosed with psychiatric illness, and this result is consistent with the recommendations in the literature.\u003c/p\u003e\u003cp\u003ePatients diagnosed with HT and CHF exhibited a markedly higher rate of postoperative intensive care unit admissions compared to those without these conditions. A similar study in the literature linked intensive care unit admissions to HT, CHF, and CVD, but reported no association between ICU admissions and other conditions, such as DM, CRF [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Courtney et al. reported that patients with CHF were followed in the intensive care unit significantly more often [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The results of our study and the literature support each other. The need for intensive care monitoring depends on many factors. One of these factors is the presence of additional comorbidities. These patients may require intensive care monitoring due to both the fracture and these comorbidities. These patients and their families should be informed that they may be admitted to intensive care before surgery, and the intensive care team should be informed in advance.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eComorbidities are one of the main determinants of mortality and morbidity after surgical treatment in hip fracture patients. The presence of comorbidities is a significant factor negatively impacting the treatment process. It is crucial to prepare detailed consent forms for hip fracture patients and their families regarding the increased risk factors these comorbidities may pose during and after treatment, and to obtain their consent to avoid legal issues. In light of the results of this study, dislocation rates in patients with CRF and CHF are higher; infection and consequently revision surgery rates, especially in patients with DM; mortality rates in the first year are higher in patients with oncological diseases; immobilization problems are common in patients with ALZ; and patients with CHF and HT require more intensive care after surgery. Effective and prompt surgical teams, aware of the potential risks, who treat elderly patients with hip fractures will reduce mortality and morbidity rates.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosures:\u003c/strong\u003e All authors have nothing to disclose\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors received no financial support for this article's research, authorship, and/or publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e: The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e The data supporting this study's findings are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e: The study followed the Declaration of Helsinki. The study was conducted with the approval of the Ondokuz University Clinical Research Ethics Committee (Decision no: 2024/350 Approval date: 22/10/2024). The study followed the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate Declarations\u003c/strong\u003e: All participants gave written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e:\u0026nbsp;Not Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003eAll participants gave written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Conception and design of the work, supervision, and manuscript drafting: E.B., Y.T.; Data collection, analysis, and interpretation of the data: E.B., T.C., F.E., H.S.C.; Statistical analysis: E.B.; Critical manuscript revision: all authors. Approval of the final manuscript: all authors.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLin FF, et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails. Medicine. 2019;98(8):e14634.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCooper C, Campion G, Melton Lr. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2:285\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWinter A, et al. The management of intracapsular hip fractures. Orthop Trauma. 2016;30(2):93\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoskins W, et al. Evidence based management of intracapsular neck of femur fractures. Hip Int. 2017;27(5):415\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGregory J, et al. 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J Orthop Surg Res. 2016;11(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDuckworth AD, et al. Deep infection after hip fracture surgery: predictors of early mortality. Injury. 2012;43(7):1182\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEnstone J, Humphreys H. Monitoring infective complications following hip fracture. J Hosp Infect. 1998;38(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEverhart JS, Altneu E, Calhoun JH. Medical comorbidities are independent preoperative risk factors for surgical infection after total joint arthroplasty. Clin Orthop Relat Research\u0026reg;. 2013;471:3112\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAcklin YP, et al. Unexpectedly increased rate of surgical site infections following implant surgery for hip fractures: problem solution with the bundle approach. Injury. 2011;42(2):209\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalem K, et al. Predictors and outcomes of treatment in hip hemiarthroplasty dislocation. Annals Royal Coll Surg Engl. 2014;96(6):446\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSierra RJ, Schleck CD, Cabanela ME. Dislocation of bipolar hemiarthroplasty: rate, contributing factors, and outcome. Clin Orthop Relat Research\u0026reg;. 2006;442:230\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGialanella B, et al. Determinants of functional outcome in hip fracture: the role of comorbidity. Aging Clin Exp Res. 2018;30:643\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLefaivre K, et al. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br Volume. 2009;91(7):922\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZuckerman JD, et al. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. JBJS. 1995;77(10):1551\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeaupre LA, et al. Best practices for elderly hip fracture patients: a systematic overview of the evidence. J Gen Intern Med. 2005;20:1019\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodgers A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVermersch C et al. \u003cem\u003eCesarean section and sismotherapy in a severe psychotic parturient: a case report\u003c/em\u003e. in \u003cem\u003eAnnales Francaises D'anesthesie et de Reanimation\u003c/em\u003e. 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcAllister N, et al. Pregnancy outcomes in women with severe needle phobia. Eur J Obstet Gynecol Reproductive Biology. 2012;162(2):149\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMİNİKSAR \u0026Ouml;, et al. Intensive Care Unit Admission Predictors of Geriatric Patients Who Underwent Hemiarthroplasty due to Hip Fracture. Volume 12. JOURNAL OF CRITICAL \u0026amp; INTENSIVE CARE; 2021. 1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCourtney P, et al. Which patients need critical care intervention after total joint arthroplasty? a prospective study of factors associated with the need for intensive care following surgery. Bone Joint J. 2015;97(11):1512\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hip fracture, Comorbidity, Mortality, Postoperative complications, Geriatrics","lastPublishedDoi":"10.21203/rs.3.rs-7768958/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7768958/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHip fractures represent a major public health concern due to their increasing incidence in the aging population and their association with significant morbidity and mortality. Comorbidities are known to complicate both the surgical management and rehabilitation process, yet their specific impact on outcomes remains variable across studies.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to determine the prevalence and distribution of comorbidities in patients who presented with hip fractures and underwent surgical treatment, to evaluate perioperative and postoperative risk factors retrospectively, and to compare these findings with the existing literature.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective descriptive analysis was conducted on 589 patients aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years who were surgically treated for hip fractures between 2013 and 2024 at a tertiary university hospital. Demographic characteristics, surgical protocols, anesthesia types, revision rates, infection, dislocation, mobilization outcomes, hospital stay, intensive care admissions, and mortality were systematically analyzed in relation to comorbidity profiles and the number of comorbidities. Statistical analyses included chi-square, Fisher\u0026rsquo;s exact test, Mann-Whitney U, and Kruskal-Wallis tests, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eHypertension (59.1%), diabetes mellitus (33.6%), coronary artery disease (21.4%), and Alzheimer\u0026rsquo;s disease (21.4%) were the most frequent comorbidities. Revision surgery was significantly associated with diabetes mellitus and congestive heart failure. Diabetes mellitus, coronary artery disease, and chronic renal failure were strong predictors of postoperative infection. While the mean hospital stay was significantly prolonged in patients with \u0026ge;\u0026thinsp;3 comorbidities, mortality was significantly associated only with oncological diseases and chronic renal failure. Contrary to expectations, no significant correlation was found between overall mortality and the number of comorbidities.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eComorbidities, particularly diabetes mellitus, congestive heart failure, oncological diseases, and chronic renal failure, substantially influence surgical outcomes, postoperative complications, and hospitalization in hip fracture patients. However, the number of comorbidities alone was not a predictor of mortality, highlighting the importance of the type rather than the quantity of comorbid conditions. These findings underscore the need for individualized perioperative planning and comprehensive patient counseling to reduce risks and improve postoperative outcomes.\u003c/p\u003e","manuscriptTitle":"Impact of Comorbidities on Preoperative and Postoperative Outcomes in Hip Fracture Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 10:58:24","doi":"10.21203/rs.3.rs-7768958/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-16T08:50:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T16:51:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226263674967264864169756010005537837633","date":"2025-12-09T16:25:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-08T19:05:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51080193717532179896806789365729824604","date":"2025-12-08T14:56:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15002363155542166998082731341707913327","date":"2025-12-08T14:52:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-22T07:53:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T13:47:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10855989426338198463005176830865011247","date":"2025-11-18T16:52:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300957523377743072253356644086081572720","date":"2025-11-16T23:42:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T10:40:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-10T15:57:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-09T07:19:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-09T07:18:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-10-02T20:26:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"585b3ef5-1569-4d84-a07e-60e268e385e8","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:02:21+00:00","versionOfRecord":{"articleIdentity":"rs-7768958","link":"https://doi.org/10.1186/s12877-026-07441-7","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-04-18 15:59:12","publishedOnDateReadable":"April 18th, 2026"},"versionCreatedAt":"2025-11-19 10:58:24","video":"","vorDoi":"10.1186/s12877-026-07441-7","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07441-7","workflowStages":[]},"version":"v1","identity":"rs-7768958","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7768958","identity":"rs-7768958","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}