Published in:
01-12-2017 | Original Article
Pre-fracture hospitalization is associated with worse functional outcome and higher mortality in geriatric hip fracture patients
Published in: Archives of Osteoporosis | Issue 1/2017
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Summary
Hip fractures are common in elderly people. Despite great progress in surgical care, the outcomes of these patients remain disappointing. This study determined pre-fracture hospital admission as a prognostic variable for inferior functional outcomes and increased mortality rates in the perioperative phase and in the first postoperative year.
Purpose
The influence of a pre-fracture hospitalization on outcomes in hip fracture patients has not yet been investigated.
Methods
Four hundred two patients who were surgically treated for hip fracture were prospectively enrolled. Patients with a hospital stay within the last 3 months prior to a hip fracture were compared to patients without a pre-fracture hospitalization. Postoperative functional outcomes and mortality rates were compared between groups at the time of hospital discharge and additionally at the six- and twelve-month follow-up appointments. A multivariate regression analysis was performed.
Results
A pre-fracture hospitalization was reported by 67 patients (17%). In 63% of cases, patients were admitted due to non-surgical, general medical conditions. In 37% of cases, patients were treated due to a condition related to a surgical subject. In the multivariate analysis, pre-fracture hospitalization was an independent risk factor for reduced values on the Barthel Index at 6 months after surgery (B, −9.918; 95%CI of B, −19.001–−0.835; p = 0.032) and on the Tinetti Test at 6 months (B, −2.914; 95%CI of B, −1.992–−0.047; p = 0.047) and 12 months after surgery (B, −4.680; 95%CI of B, −8.042–−1.319; p = 0.007). Pre-fracture hospitalization was additionally associated with increased mortality rates at 6 months (OR 1.971; 95%CI 1.052–3.693; p = 0.034) and 12 months after surgery (OR 1.888; 95%CI 1.010–9.529; p = 0.046).
Conclusions
Hip fracture patients with a recent pre-fracture hospital admission are at a substantial risk for inferior functional outcomes and increased mortality rates not only in the perioperative phase but also in the first postoperative year. As a simple dichotomous variable, pre-fracture hospitalization might be a suitable tool for future geriatric hip fracture screening instruments.