Functional outcome and survival after hip fracture in elderly: a prospective study of 106 consecutive patients

Abstract

Hip fracture is one of the most common, costly, and devastating injuries suffered by elderly. We prospectively analysed the recovery of hip fracture patients in an area of 92 500 inhabitants comprising six municipalities (A-F). Ambulation, functional capacity and survival of 106 consecutive hip fracture patients whose mean age was 79 years (SD=10) were followed for one year. Functional capacity was measured at two weeks, four months and twelve months postoperatively. Locomotor ability was evaluated pre- and postoperatively. Life table method was used in survival analysis. There was a significant decrease in the mean functional capacity of the patients at twelve months compared to the situation prior to the fracture (p=0.001). Prior to the fracture, 59% of the patients were moving without any assistive devices, but one year after fracture only 19% were able to do this. Similarly, not one of the patients was confined to bed before the fracture, but 11% of those who were alive after one year had become bed-ridden (p<0.001). Overall mortality rate was 32%. Age <80 years (OR=7.3; 95% CI, 2.3–23.1), residence in municipalities A and B (OR=4.2; 95% CI, 1.4–12.4 ) and ASA classes 1–3 (OR=5.2; 95% CI, 1.8–15.4) were positive factors for one-year survival. Patients from municipalities A and B (49% of all patients) whose post-acute care was given in the same rehabilitation department of one hospital recovered best. The locomotor ability of the patients decreased significantly in the first postoperative year. It seems that the centralisation of post-acute rehabilitation improves the functional outcome of these patients.