Hip operations - at age 100 and older

They say centenarians operated on after hip fractures had better outcomes than those who relied on medication

Doctors at Tan Tock Seng Hospital (TTSH) say there is no such thing as being too old for surgery, especially after a hip fracture.

In a letter to the Annals, the publication of the Academy of Medicine, Dr Ernest Kwek of TTSH and Dr Wei Xiang Ng of MOH Holdings said: "Management of centenarian hip fracture is especially challenging, as both healthcare providers and patients may be unwilling to consider corrective hip surgery in view of their age and perceived high anaesthetic risks."

Hence, the hospital's decision to study the fracture outcomes of centenarians here.

TTSH found that those who had surgery were better able to retain their ability to walk, and that death within a year of their fall was lower than among those who did not get operated on.

Orthopaedic surgeons at TTSH have operated on six out of 13 centenarians who had hip fractures over a nine-year period.

One recovered well enough to be able to walk unaided, while four needed a walking stick. Their ages ranged from 100 to 107. The last patient could not walk.

Four of them lived beyond a year after the fracture, including the oldest who fractured her hip at the age of 107. None of the deaths was related to the surgery.

Dr Kwek, a senior orthopaedic surgeon at TTSH, said: "This was contrary to the common belief that centenarians generally have higher surgical risks of post-operative-related complications and mortality."

Among those who did not go for surgery and relied on pain medication instead, two could walk unaided, two with the aid of sticks, and the other three could not walk. Four in this group died within a year of the injury.

"Centenarians tend to be healthier than most elderly patients... since most of those with multiple co-morbidities would have died earlier from complications of those diseases," said Dr Kwek.

Associate Professor Joyce Koh, a senior orthopaedic surgeon at Singapore General Hospital (SGH), agreed that "age should not be a deterrent for surgery".

She said patients deemed fit enough for surgery, no matter their ages, are likely to have better outcomes and lower rates of death. But she added that patients who are already bedbound before the fracture would benefit less from surgery.

She said: "Doctors will assess the patient's suitability for operation based on the health status and medical condition. A patient may not be too old for surgery but can be very sick due to various medical conditions."

Dr Wong Siang Yih, a senior surgeon at Changi General Hospital (CGH), agreed that age is not a barrier. He said doctors at CGH would operate on people over the age of 100 as long as they are fit for surgery.

Doctors at SGH have operated on five centenarians who had fractured their hips over the past six years.

Prof Koh also agreed with Dr Kwek that "nanogenerians and centenarians are naturally-selected cohorts who already demonstrate longevity die to low or well-controlled co-morbid conditions."

She added that hip fractures will be a looming problem, given Singapore's rapidly ageing population. It is part of "a fast appearing musculoskeletal epidemic" she forecasts.

In 2015, Singapore had about 1,100 people over the age of 100. The number is expected to go up with increasing life expectancy and an ageing population.

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A version of this article appeared in the print edition of The Straits Times on August 22, 2017, with the headline 'Never too old for surgery, say doctors'. Print Edition | Subscribe