The effects of psoas muscle area and subcutaneous fat tissue area on postoperative comorbidities at geriatric hip fractures

Purpose Geriatric hip fracture is a universal cause of morbidity and mortality today. Our study aims to determine the causes of morbidity and mortality in the postoperative period in geriatric patients with hip fractures, to reveal predictive factors and to facilitate the implementation of protective measures. In the postoperative period, it is necessary to determine the causes of morbidity and mortality and to manage comorbidities correctly. In our study, the psoas muscle area and subcutaneous fat tissue area, as well as comorbid diseases, previous fracture history, albumin and neutrophil/lymphocyte ratio values, and anticoagulant use were evaluated in the postoperative period, wound discharge, intensive care admission and mortality risks. Since it is one of the most comprehensive studies conducted on this subject, it is aimed to make a significant contribution to the literature with the results obtained. Material and Method A total of 204 patients diagnosed with 'Hip Fracture', who were over 65 years old, surgically treated in our clinic and had at least 1 year of clinical and radiological follow-up, were evaluated retrospectively. A total of 204 patients, 129 female and 75 male, were selected. Two groups were formed from patients who underwent proximal femoral nailing and hemiarthroplasty. The patients in the study group were included in the study by checking their hemogram and biochemistry tests, pelvic radiographs, lumbar and pelvic tomography scans through the system. From the hemogram and biochemistry tests; early post-trauma neutrophil/lymphocyte ratio and albumin levels were evaluated. The psoas muscle area and subcutaneous fat tissue area were measured and evaluated from the obtained computerized tomography imaging methods. The relationship between the data obtained from the patients and the applied surgical method was evaluated. The patients were also grouped separately according to their accompanying diseases. Postoperative complications, intensive care unit stays and mortality rates were evaluated. Results As a result of our measurements and statistical evaluation, it was observed that the psoas muscle area and subcutaneous fat tissue area did not significantly affect wound discharge (p>0.05). 15 However, these values are very close to the significance limit for subcutaneous fat tissue and it is thought that significant results can be obtained when evaluated with larger-scale studies. There was no significant difference in psoas muscle area between patient groups with and without a history of fracture (p>0.05). When mortality was examined, it was observed that the increase in psoas muscle area and subcutaneous fat tissue significantly reduced the mortality of patients in the postoperative period (p<0.05). When biochemical indicators were examined, it was observed that, unlike the literature, the albumin values and neutrophil/lymphocyte ratios measured in patients with hip fractures did not have a significant effect on wound site problems (p>0.05). However, the neutrophil/lymphocyte ratio value was very close to the significance limit and it is thought that significant results can be obtained when evaluated with larger-scale studies. It was observed that low albumin values and neutrophil/lymphocyte ratios were significantly correlated with increased postoperative mortality (p<0.05). Additional diseases were evaluated under five headings as cardiac, metabolic, renal, respiratory and neurological, and according to the data we obtained, it was observed that the comorbid diseases included in our study - except thyroid dysfunctions - significantly affected the risk of hip fracture formation and mortality rate (p<0.05). Anticoagulant use of the patients was also evaluated in our study. It was observed that the mortality rates of patients who used anticoagulants before the fracture process due to their chronic diseases were lower than those who did not use them (p<0.05). The mortality rate in patients who went to intensive care in the postoperative period was significantly higher than those who were followed up in the ward. It was observed that the comorbidity rate was significantly higher (p<0.05) in the group that was admitted to the intensive care unit than in the group that was followed up in the ward. The amount of subcutaneous fat was significantly lower (p<0.05) in the exitus group. According to the data we obtained in our study, no significant difference was observed between the proximal femoral nail and hemiarthroplasty groups in terms of wound discharge, admission to intensive care and mortality (p>0.05). Conclusion The imaging and biochemical tests obtained at the time of admission of patients who underwent proximal femoral nail and hemiarthroplasty surgical procedures were analyzed in detail. Our study showed that the psoas muscle area and subcutaneous fat tissue area were closely related to mortality and postoperative comorbidities. The most striking result of our study is that the surgical procedure did not affect the wound site result. It was shown that it is possible to 16 determine the prognosis from the preoperative imaging and biochemical results obtained at the time of admission. Keywords: Psoas muscle area, Subcutaneous fat tissue area, Proximal femur nail, Hemiarthroplasty, Comorbid diseases, Wound discharge, Albumin, Neutrophil/Lymphocyte Ratio