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Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights® to this article was published on 19 April 2013

Abstract

Background

Hip fractures in the elderly are followed by considerable risk of functional decline and mortality.

Questions/purposes

The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures.

Methods

A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables.

Results

Conclusions

Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–1650.

    Article  PubMed  CAS  Google Scholar 

  2. Al-Ani AN, Samuelsson B, Tidermark J, Norling Ã, Ekstrãm W, Cederholm T, Hedström M. Early operation on patients with a hip fracture improved the ability to return to independent living: a prospective study of 850 patients. J Bone Joint Surg Am. 2008;90:1436–1442.

    Article  PubMed  Google Scholar 

  3. Alegre-Lopez J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernandez-Melon J. Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int. 2005;16:729–736.

    Article  PubMed  Google Scholar 

  4. Allman RM, Goode PS, Burst N, Bartolucci AA, Thomas DR. Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Adv Wound Care. 1999;12:22–30.

    PubMed  CAS  Google Scholar 

  5. Bass E, French DD, Bradham DD, Rubenstein LZ. Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol. 2007;17:514–519.

    Article  PubMed  Google Scholar 

  6. Baumgarten M, Margolis DJ, Orwig DL, Shardell MD, Hawkes WG, Langenberg P, Palmer MH, Jones PS, McArdle PF, Sterling R, Kinosian BP, Rich SE, Sowinski J, Magaziner J. Pressure ulcers in elderly patients with hip fracture across the continuum of care. J Am Geriatr Soc. 2009;57:863–870.

    Article  PubMed  Google Scholar 

  7. Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int. 2004;15:87–94.

    Article  PubMed  Google Scholar 

  8. Fiedler RC, Granger CV, Russell CF. UDS(MR)SM: follow-up data on patients discharged in 1994–1996: Uniform Data System for Medical Rehabilitation. Am J Phys Med Rehabil. 2000;79:184–192.

    Article  PubMed  CAS  Google Scholar 

  9. Givens JL, Sanft TB, Marcantonio ER. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc. 2008;56:1075–1079.

    Article  PubMed  Google Scholar 

  10. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, Nixon J; European Quality of Life Pressure Ulcer Project group. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009;57:1175–1183.

    Article  PubMed  Google Scholar 

  11. Greendale GA, DeAmicis TA, Bucur A, Bretsky P, Rowe JW, Reuben DB, Seeman T. A prospective study of the effect of fracture on measured physical performance: results from the MacArthur Study—MAC. J Am Geriatr Soc. 2000;48:546–549.

    PubMed  CAS  Google Scholar 

  12. Gustafson Y, Berggren D, Brannstrom B, Bucht G, Norberg A, Hansson LI, Winblad B. Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc. 1988;36:525–530.

    PubMed  CAS  Google Scholar 

  13. Handoll HH, Cameron ID, Mak JC, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2009;4:CD007125.

    PubMed  Google Scholar 

  14. Hershkovitz A, Kalandariov Z, Hermush V, Weiss R, Brill S. Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Arch Phys Med Rehabil. 2007;88:916–921.

    Article  PubMed  Google Scholar 

  15. Hokby A, Reimers A, Laflamme L. Hip fractures among older people: do marital status and type of residence matter? Public Health. 2003;117:196–201.

    Article  PubMed  CAS  Google Scholar 

  16. Hutchings L, Fox R, Chesser T. Proximal femoral fractures in the elderly: how are we measuring outcome? Injury. 2011;42:1205–1213.

    Article  PubMed  Google Scholar 

  17. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–676.

    Article  PubMed  CAS  Google Scholar 

  18. Jones CA, Feeny DH. Agreement between patient and proxy responses during recovery after hip fracture: evidence for the FIM instrument. Arch Phys Med Rehabil. 2006;87:1382–1387.

    Article  PubMed  Google Scholar 

  19. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359:1929–1936.

    Article  PubMed  Google Scholar 

  20. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality: relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res. 1984;186:45–56.

    PubMed  Google Scholar 

  21. Koot VC, Peeters PH, de Jong JR, Clevers GJ, van der Werken C. Functional results after treatment of hip fracture: a multicentre, prospective study in 215 patients. Eur J Surg. 2000;166:480–485.

    Article  PubMed  CAS  Google Scholar 

  22. Lieberman D, Friger M, Lieberman D. Inpatient rehabilitation outcome after hip fracture surgery in elderly patients: a prospective cohort study of 946 patients. Arch Phys Med Rehabil. 2006;87:167–171.

    Article  PubMed  Google Scholar 

  23. Lundstrom M, Edlund A, Bucht G, Karlsson S, Gustafson Y. Dementia after delirium in patients with femoral neck fractures. J Am Geriatr Soc. 2003;51:1002–1006.

    Article  PubMed  Google Scholar 

  24. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55:M498–507.

    Article  PubMed  CAS  Google Scholar 

  25. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol. 1990;45:M101–107.

    Article  PubMed  CAS  Google Scholar 

  26. Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000;48:618–624.

    PubMed  CAS  Google Scholar 

  27. McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med. 2002;162:457–463.

    Article  PubMed  Google Scholar 

  28. Michel JP, Klopfenstein C, Hoffmeyer P, Stern R, Grab B. Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome? Aging Clin Exp Res. 2002;14:389–394.

    PubMed  Google Scholar 

  29. Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004;291:1738–1743.

    Article  PubMed  CAS  Google Scholar 

  30. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–243.

    Article  PubMed  CAS  Google Scholar 

  31. Panula J, Pihlajamaki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P, Kivela SL. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord. 2011;12:105.

    Article  PubMed  Google Scholar 

  32. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23:433–441.

    PubMed  CAS  Google Scholar 

  33. Pioli G, Barone A, Giusti A, Oliveri M, Pizzonia M, Razzano M, Palummeri E. Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res. 2006;18:381–387.

    PubMed  CAS  Google Scholar 

  34. Robertson BD, Robertson TJ. Postoperative delirium after hip fracture. J Bone Joint Surg Am. 2006;88:2060–2068.

    Article  PubMed  Google Scholar 

  35. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374.

    Article  PubMed  CAS  Google Scholar 

  36. Rockwood K, Cosway S, Carver D, Jarrett P, Stadnyk K, Fisk J. The risk of dementia and death after delirium. Age Ageing. 1999;28:551–556.

    Article  PubMed  CAS  Google Scholar 

  37. Rogers FB, Shackford SR, Keller MS. Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma. 1995;39:261–265.

    Article  PubMed  CAS  Google Scholar 

  38. Rutledge T, Matthews K, Lui LY, Stone KL, Cauley JA. Social networks and marital status predict mortality in older women: prospective evidence from the Study of Osteoporotic Fractures (SOF). Psychosom Med. 2003;65:688–694.

    Article  PubMed  Google Scholar 

  39. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth. 2008;55:146–154.

    Article  PubMed  Google Scholar 

  40. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182:1609–1616

    PubMed  Google Scholar 

  41. Soderqvist A, Ekstrom W, Ponzer S, Pettersson H, Cederholm T, Dalen N, Hedstrom M, Tidermark J; Stockholm Hip Fracture Group. Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology. 2009;55:496–504.

    Article  PubMed  Google Scholar 

  42. Soderqvist A, Miedel R, Ponzer S, Tidermark J. The influence of cognitive function on outcome after a hip fracture. J Bone Joint Surg Am. 2006;88:2115–2123.

    Article  PubMed  Google Scholar 

  43. Spilsbury K, Nelson A, Cullum N, Iglesias C, Nixon J, Mason S. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. J Adv Nurs. 2007;57:494–504.

    Article  PubMed  Google Scholar 

  44. Stausberg J, Kiefer E. Classification of pressure ulcers: a systematic literature review. Stud Health Technol Inform. 2009;146:511–515.

    PubMed  Google Scholar 

  45. van Balen R, Steyerberg EW, Polder JJ, Ribbers TL, Habbema JD, Cools HJ. Hip fracture in elderly patients: outcomes for function, quality of life, and type of residence. Clin Orthop Relat Res. 2001;390:232–243.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Ministry of Education and Science of Serbia, contracts No. 175046, 2011–2014.

Author information

Authors and Affiliations

  1. Clinic for Physical Medicine and Rehabilitation, Clinical Center Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia

    Emilija Dubljanin-Raspopović MD, PhD

  2. Institute of Epidemiology, School of Medicine, Faculty of Medicine, University of Belgrade, Višegradska 26, 11000, Belgrade, Serbia

    Ljiljana Marković-Denić MD, PhD

  3. Institute of Medical Statistics and Medical Informatics, Faculty of Medicine, University of Belgrade, Dr Subotića 15, 11000, Belgrade, Serbia

    Jelena Marinković MD, PhD

  4. Clinic for Physical Medicine and Rehabilitation, Clinical Center Serbia, Pasterova 2, 11000, Belgrade, Serbia

    Una Nedeljković MD

  5. Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia, Faculty of Medicine, University of Belgrade, Višegradska 26, 11000, Belgrade, Serbia

    Marko Bumbaširević MD, PhD

Authors
  1. Emilija Dubljanin-Raspopović MD, PhD
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  2. Ljiljana Marković-Denić MD, PhD
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  3. Jelena Marinković MD, PhD
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  4. Una Nedeljković MD
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Corresponding author

Correspondence to Emilija Dubljanin-Raspopović MD, PhD.

Additional information

One or more of the authors (ED-R, LM-D) has received funding from the Ministry of Education and Science, Contract No. 175046, 2011–2014.

Each other author certifies that he, she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia, Belgrade, Serbia.

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Dubljanin-Raspopović, E., Marković-Denić, L., Marinković, J. et al. Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?. Clin Orthop Relat Res 471, 2703–2710 (2013). https://doi.org/10.1007/s11999-013-2955-1

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  • DOI: https://doi.org/10.1007/s11999-013-2955-1

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