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Pre-fracture hospitalization is associated with worse functional outcome and higher mortality in geriatric hip fracture patients

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Abstract

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.

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References

  1. Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med 3:1–17

    PubMed  PubMed Central  Google Scholar 

  2. Icks A, Arend W, Becker C, Rapp K, Jungbluth P, Haastert B (2013) Incidence of hip fractures in Germany, 1995-2010. Arch Osteoporos 8:140

    Article  PubMed  Google Scholar 

  3. White SM, Griffiths R (2011) Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury 42:1230–1233

    Article  CAS  PubMed  Google Scholar 

  4. Buecking B, Struewer J, Waldermann A, Horstmann K, Schubert N, Balzer-Geldsetzer M, Dodel R, Bohl K, Ruchholtz S, Bliemel C (2014) What determines health-related quality of life in hip fracture patients at the end of acute care?—a prospective observational study. Osteoporos Int 25:475–484

    Article  CAS  PubMed  Google Scholar 

  5. Schousboe JT, Paudel ML, Taylor BC, Kats AM, Virnig BA, Dowd BE, Langsetmo L, Ensrud KE (2017) Pre-fracture individual characteristics associated with high total health care costs after hip fracture. Osteoporos Int 28:889–899

    Article  CAS  PubMed  Google Scholar 

  6. Aigner R, Meier Fedeler T, Eschbach D, Hack J, Bliemel C, Ruchholtz S, Bücking B (2016) Patient factors associated with increased acute care costs of hip fractures: a detailed analysis of 402 patients. Arch Osteoporos 11:38

    Article  CAS  PubMed  Google Scholar 

  7. Bliemel C, Sielski R, Doering B, Dodel R, Balzer-Geldsetzer M, Ruchholtz S, Buecking B (2016) Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture-development of a new scoring system. Osteoporos Int 27:1979–1987

    Article  CAS  PubMed  Google Scholar 

  8. Reuling EM, Sierevelt IN, van den Bekerom MP, Hilverdink EF, Schnater JM, van Dijk CN, Goslings JC, Raaymakers EL (2012) Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score. Arch Orthop Trauma Surg 132:249–256

    Article  PubMed  Google Scholar 

  9. Kim SM, Moon YW, Lim SJ, Yoon BK, Min YK, Lee DY, Park YS (2012) Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 50:1343–1350

    Article  PubMed  Google Scholar 

  10. Butler M, Forte ML, Joglekar SB, Swiontkowski MF, Kane RL (2011) Evidence summary: systematic review of surgical treatments for geriatric hip fractures. J Bone Joint Surg Am 93:1104–1115

    Article  PubMed  Google Scholar 

  11. McCusker J, Bellavance F, Cardin S, Trépanier S, Verdon J, Ardman O (1999) Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 47:1229–1237

    Article  CAS  PubMed  Google Scholar 

  12. Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  CAS  PubMed  Google Scholar 

  13. www.asahq.org/clinical/physicalstatus.html AAApscs Accessed June 10 2014

  14. Lübke N, Meinck M, Von Renteln-Kruse W (2004) The Barthel Index in geriatrics. A context analysis for the Hamburg Classification Manual. Z Gerontol Geriatr 37:316–326

    Article  PubMed  Google Scholar 

  15. Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34:119–126

    Article  CAS  PubMed  Google Scholar 

  16. Ercin E, Bilgili MG, Sari C, Basaran SH, Tanriverdi B, Edipoglu E, Celen KM, Cetingok H, Kural C (2017) Risk factors for mortality in geriatric hip fractures: a compressional study of different surgical procedures in 785 consecutive patients. Eur J Orthop Surg Traumatol 27:101–106

    Article  PubMed  Google Scholar 

  17. Kirkland LL, Kashiwagi DT, Burton MC, Cha S, Varkey P (2011) The Charlson Comorbidity Index Score as a predictor of 30-day mortality after hip fracture surgery. Am J Med Qual 26:461–467

    Article  PubMed  Google Scholar 

  18. Koval KJ, Skovron ML, Polatsch D, Aharonoff GB, Zuckerman JD (1996) Dependency after hip fracture in geriatric patients: a study of predictive factors. J Orthop Trauma 10:531–535

    Article  CAS  PubMed  Google Scholar 

  19. Iosifidis M, Iliopoulos E, Panagiotou A, Apostolidis K, Traios S, Giantsis G (2016) Walking ability before and after a hip fracture in elderly predict greater long-term survivorship. J Orthop Sci 21:48–52

    Article  PubMed  Google Scholar 

  20. Dubljanin-Raspopović E, Marković-Denić L, Marinković J, Nedeljković U, Bumbaširević M (2013) Does early functional outcome predict 1-year mortality in elderly patients with hip fracture? Clin Orthop Relat Res 471:2703–2710

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kates SL, Behrend C, Mendelson DA, Cram P, Friedman SM (2015) Hospital readmission after hip fracture. Arch Orthop Trauma Surg 135:329–337

    Article  PubMed  Google Scholar 

  22. Ariza-Vega P, Jiménez-Moleón JJ, Kristensen MT (2014) Change of residence and functional status within three months and one year following hip fracture surgery. Disabil Rehabil 36:685–690

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to acknowledge Lutz Waschnick, Natalie Schubert, Anna Waldermann, Kristin Horstmann, and Anne Hemesath for their contributions to the acquisition of data.

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Authors and Affiliations

  1. Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Rene Aigner, Benjamin Buecking, Juliana Hack, Daphne Eschbach, Ludwig Oberkircher, Steffen Ruchholtz & Christopher Bliemel

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  1. Rene Aigner
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  2. Benjamin Buecking
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  3. Juliana Hack
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  4. Daphne Eschbach
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  5. Ludwig Oberkircher
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  6. Steffen Ruchholtz
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  7. Christopher Bliemel
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Contributions

RA substantially contributed to the acquisition of data, analysis and interpretation of data, drafting of the article, and approval of the version to be published.

BB substantially contributed to the analysis and interpretation of data, critical revision of the article for important intellectual content, and approval of the version to be published.

JH substantially contributed to the analysis and interpretation of data, critical revision of the article for important intellectual content, and approval of the version to be published.

DE substantially contributed to the conception and design of the study, analysis and interpretation of data, critical revision of the article for important intellectual content, and approval of the version to be published.

LO substantially contributed to the conception and design of the study, application for ethical approval, database set-up, critical revision of the article for important intellectual content, and approval of the version to be published.

SR substantially contributed to the conception and design, critical revision of the article for important intellectual content, and approval of the version to be published.

CB substantially contributed to the conception and design, acquisition of data, analysis and interpretation of data, drafting of the article, and approval of the version to be published.

Corresponding author

Correspondence to Christopher Bliemel.

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Aigner, R., Buecking, B., Hack, J. et al. Pre-fracture hospitalization is associated with worse functional outcome and higher mortality in geriatric hip fracture patients. Arch Osteoporos 12, 32 (2017). https://doi.org/10.1007/s11657-017-0327-2

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