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The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Hip fracture patients are fragile, and the majority fail to fully recover to their pre-fracture functional level, resulting in an increase in institutionalization. We aimed to investigate risk factors for being dependent at discharge and for failure to return to independent living 12 months after a hip fracture.

Materials and methods

From 2011 to 2017, all surgically treated hip fracture patients admitted from their own homes were included in this prospective cohort study. Patient characteristics were registered, including age, sex, lifestyle, comorbidities, pre-fracture New Mobility Score (NMS), biochemical measures, fracture type, and surgical method. Dependency was measured at discharge using a cumulated ambulatory score (CAS < 6) and the timed-up-and-go test (TUG > 20 s). At 12 months, patients were interviewed regarding residence, NMS, and care needs. Multivariable logistic regression was used, reporting odds ratio (OR) with 95% confidence intervals (CI).

Results

A total of 2006 patients were included in the study with data regarding their hospital stay and discharge. In all, 1342 patients underwent follow-up at 12 months. The risk factors found to be associated with dependency at discharge were mostly static. Modifiable variables associated with dependency at discharge (CAS < 6) were hypoalbuminemia (OR: 1.94, 95% CI 1.38–2.71), not having been mobilized to standing within 24 h (OR: 1.88, 95% CI 1.12–3.15), and general anesthesia (OR: 1.35, 95% CI 1.07–1.71). Failure to return to independent living at 12 months was found in 10% of the patients, and was primarily associated with patient characteristics and proxy variables for comorbidities, but also with dependency at discharge (CAS < 6).

Conclusions

Mobilizing patients to standing within 24 h from hip fracture surgery was vital in maximizing short-term functional recovery. Failure to return to independent living was seen in the frailest patients. However, the majority remained in their own home with little increase in care needs.

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Availability of data and materials

The study protocol and data analysis files are available upon reasonable request to the corresponding author. For data sharing, relevant local authorities need to grant permission.

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Funding

This study was funded by the department only and has not received any external funding.

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Authors and Affiliations

  1. Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Gødstrupvej 43, 7400, Herning, Denmark

    Christina Frölich Frandsen, Maiken Stilling, Eva Natalia Glassou & Torben Bæk Hansen

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Christina Frölich Frandsen, Maiken Stilling & Torben Bæk Hansen

  3. Department of Quality, Gødstrup Hospital, Herning, Denmark

    Eva Natalia Glassou

  4. Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark

    Maiken Stilling

Authors
  1. Christina Frölich Frandsen
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  2. Maiken Stilling
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  4. Torben Bæk Hansen
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Contributions

All authors contributed to the study’s conception and design. Data collection was performed by MS, Torben Bæk Hansen, and Christina Frølich Frandsen. Eva Natalia Glassou and Christina Frølich Frandsen performed the analyses. Christina Frølich Frandsen prepared the first draft of the manuscript, and all authors read, revised, and approved the final manuscript.

Corresponding author

Correspondence to Christina Frölich Frandsen.

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The authors have no competing interests to declare relevant to this article's contents.

Ethics approval

The study was registered with the Danish Data Protection Agency (number 2007–58-0010). Under Danish law, no requirement for approval from the National Ethics committee applied.

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Under Danish law, no requirement for written consent applies.

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Frandsen, C.F., Stilling, M., Glassou, E.N. et al. The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study. Arch Orthop Trauma Surg 143, 2475–2484 (2023). https://doi.org/10.1007/s00402-022-04472-8

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