Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients

Abstract

This study was designed to investigate predictable factors of mortality, second fracture, and functional recovery within 24 months of hip fracture surgery in elderly patients. In addition, the authors sought to identify differences in survival and functional outcomes according to fracture type. Four hundred and fifteen patients with acute, first-time and lower-energy trauma hip fractures were enrolled into this prospective cohort study and followed for a minimum of 24 months. The potential risk factors of mortality and functional outcomes considered were; (1) age, gender, body mass index, previous fracture history, preoperative ambulatory ability and residency type; (2) 8 comorbidity items, cognitive impairment, smoking, and American Society of Anesthesiologists' classification; and (3) delay prior to surgery, fracture type, operation time, operation method, and postoperative fall history. Multivariate logistic regression and Cox regression models were used for analysis. One-year and 2-year mortality rates after hip fracture surgery were 14.7% and 24.3%, respectively. The 2-year second fracture rate was 9.2% and the 2-year functional recovery rate was 38.6%. Advanced age, cancer, a prior fracture history, and a solitary life were found to be significantly associated with the risk of increased 2-year mortality. A fall within 1 year of surgery and a solitary life were found to be closely associated with the risk of a second fracture, and malignancy and cognitive impairment with a poor functional outcome. Operation time and the 2-year second fracture rate differed significantly between the two fracture groups. An understanding of the incidences and risk factors of mortality and postoperative outcomes following hip fracture surgery in elderly patients provides a valuable basis to improve in health care of geriatric population.