Factors Affecting Postoperative Functional Outcomes in Older Patients with Hip Fractures at a Large Public Hospital in Thailand
DOI:
https://doi.org/10.56929/jseaortho-023-0175Keywords:
older person, hip fracture, time to surgery, fragility fracture, functional outcome, prognostic factorAbstract
Purpose: To identify prognostic factors for 6-month postoperative functional outcomes in older patients with hip fractures.
Methods: This single-center prospective cohort study was conducted from January 2020 to December 2020. Patient factors and the preinjury Barthel index were collected from the patients at admission. The Barthel index was assessed again 6 months postoperatively to define functional outcomes. Minimal clinically important differences (MCIDs) between preinjury and 6-month functional outcomes were used to classify patients into satisfactory or unsatisfactory groups. The 6-month mortality rate was evaluated. Multiple logistic regression was used to analyze prognostic factors for postoperative functional outcomes.
Results: In total, 320 patients were included in the analysis. The 6-month mortality rate was 11.8%. The average age and body mass index were 75.74±10.53 years and 20.98±3.96, respectively. Of the patients, 243 were female (75.94%), 210 were diagnosed with intertrochanteric fractures (65.83%), and 54 underwent surgery within 72 h (16.88%). In total, 249 patients (77.81%) had no complications. Multivariate analysis indicated that a time to surgery of < 72 h (odds ratio, 10.51; 95% confidence interval (CI), 5.42 to 20.37; p-value <0.01) was a significant prognostic factor for a satisfactory 6-month outcome.
Conclusions: Time to surgery is a prognostic factor for a satisfactory functional outcome. Early surgery results in better functional outcomes in older patients with hip fractures.
Metrics
References
Amarilla-Donoso FJ, López-Espuela F, Roncero-Martín R, et al. Quality of life in elderly people after a hip fracture: a prospective study. Health Qual Life Outcomes 2020;18:71. DOI: https://doi.org/10.1186/s12955-020-01314-2
Wendt K, Heim D, Josten C, et al. Recommendations on hip fractures. Eur J Trauma Emerg Surg 2016;42:425-31. DOI: https://doi.org/10.1007/s00068-016-0684-3
Sucharitpongpan W, Daraphongsataporn N, Saloa S, et al. Epidemiology of fragility hip fractures in Nan, Thailand. Osteoporos Sarcopenia 2019;5:19-22. DOI: https://doi.org/10.1016/j.afos.2019.03.003
Lewsirirat S, Thanomsingh P. Mortality and ambulatory status after intertrochanteric fracture treated at Maharat Nakhon Ratchasima Hospital, Thailand. JRCOST 2010;34:5-12.
Choovongkomol K, Lewsirirat S, Piyapromdee U. Mortality and prognosis factors of elderly patients with pertrochanteric fracture: Re-evaluation in Maharat Nakhon Ratchasima Hospital. JRCOST 2015;39:3-9.
Takahashi A, Naruse H, Kitade I, et al. Functional outcomes after the treatment of hip fracture. PLoS ONE. 2020;15:e0236652. DOI: https://doi.org/10.1371/journal.pone.0236652
van de Ree CLP, De Jongh MAC, Peeters CMM, et al. Hip fractures in elderly people: Surgery or no surgery? A systematic review and meta-analysis. Geriatr Orthop Surg Rehabil 2017;8: 173-80. DOI: https://doi.org/10.1177/2151458517713821
Jamal Sepah Y, Umer M, Khan A, et al. Functional outcome, mortality and in-hospital complications of operative treatment in elderly patients with hip fractures in the developing world. Int Orthop 2010;34:431-5. DOI: https://doi.org/10.1007/s00264-009-0803-4
Chen YP, Kuo YJ, Liu CH, et al. Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study. Ther Adv Musculoskelet Dis 2021;13:1759720X211028360. DOI: https://doi.org/10.1177/1759720X211028360
Haentjens P, Autier P, Barette M, et al. Survival and functional outcome according to hip fracture type: a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture. Bone 2007;41:958-64. DOI: https://doi.org/10.1016/j.bone.2007.08.026
Adulkasem N, Phinyo P, Khorana J, et al. Prognostic factors of 1-year postoperative functional outcomes of older patients with intertrochanteric fractures in Thailand: A retrospective cohort study. Int J Environ Res Public Health 2021;18:6896. DOI: https://doi.org/10.3390/ijerph18136896
Anusitviwat C, Vanitcharoenkul E, Chotiyarnwong P, et al. Surgical treatment for fragility hip fractures during the COVID-19 pandemic resulted in lower short-term postoperative functional outcome and a higher complication rate compared to the pre-pandemic period. Osteoporos Int 2022;33:2217-26. DOI: https://doi.org/10.1007/s00198-022-06485-w
Dajpratham P, Meenaphant R, Junthon P, et al. The inter-rater reliability of Barthel Index (Thai version) in stroke patients. J Thai Rehabil 2006; 16:1-9
Unnanuntana A, Jarusriwanna A, Nepal S. Validity and responsiveness of Barthel index for measuring functional recovery after hemiarthroplasty for femoral neck fracture. Arch Orthop Trauma Surg 2018;138:1671-7. DOI: https://doi.org/10.1007/s00402-018-3020-z
Di Monaco M, Castiglioni C, Di Carlo S, et al. Classes of vitamin D status and functional outcome after hip fracture: a prospective, short-term study of 1350 inpatients. Eur J Phys Rehabil Med 2019;55:56-62. DOI: https://doi.org/10.23736/S1973-9087.18.05191-2
Seng WRD, Belani MH, Ramason R, et al. Functional improvement in geriatric hip fractures: Does vitamin D deficiency affect the functional outcome of patients with surgically treated intertrochanteric hip fractures. Geriatr Orthop Surg Rehabil 2015;6:186-91. DOI: https://doi.org/10.1177/2151458515584639
Sim DS, Tay K, Howe TS, et al. Preoperative severe vitamin D deficiency is a significant independent risk factor for poorer functional outcome and quality of life 6 months after surgery for fragility hip fractures. Osteoporos Int 2021;32:2217-24. DOI: https://doi.org/10.1007/s00198-021-05970-y
Tay E. Hip fractures in the elderly: operative versus nonoperative management. Singapore Med J 2016;57:178-81. DOI: https://doi.org/10.11622/smedj.2016071
Hornby R, Evans JG, Vardon V. Operative or conservative treatment for trochanteric fractures of the femur. A randomised epidemiological trial in elderly patients. J Bone Joint Surg Br 1989;71:619-23. DOI: https://doi.org/10.1302/0301-620X.71B4.2670950
Klestil T, Röder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 2018;8:13933. DOI: https://doi.org/10.1038/s41598-018-32098-7
Pincus D, Ravi B, Wasserstein D, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA 2017;318:1994-2003. DOI: https://doi.org/10.1001/jama.2017.17606
Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004;291:1738-43. DOI: https://doi.org/10.1001/jama.291.14.1738
Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 2010;182:1609-16. DOI: https://doi.org/10.1503/cmaj.092220
Paul P, Issac RT. Delay in time from fracture to surgery: A potential risk factor for in-hospital mortality in elderly patients with hip fractures. J Orthop 2018;15:375-8. DOI: https://doi.org/10.1016/j.jor.2018.03.001
Nikkel LE, Kates SL, Schreck M, et al. Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study. BMJ 2015;351:h6246. DOI: https://doi.org/10.1136/bmj.h6246
Simunovic N, Devereaux PJ, Bhandari M. Surgery for hip fractures: Does surgical delay affect outcomes?. Indian J Orthop 2011;45:27-32. DOI: https://doi.org/10.4103/0019-5413.73660
Rodriguez-Fernandez P, Adarraga-Cansino D, Carpintero P. Effects of delayed hip fracture surgery on mortality and morbidity in elderly patients. Clin Orthop Relat Res 2011;469:3218-21. DOI: https://doi.org/10.1007/s11999-010-1756-z
Yonezawa T, Yamazaki K, Atsumi T, et al. Influence of the timing of surgery on mortality and activity of hip fracture in elderly patients. J Orthop Sci 2009;14:566-73. DOI: https://doi.org/10.1007/s00776-009-1380-5
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
