Loss of Ambulatory Level and Activities of Daily Living at 1 Year Following Hip Fracture: Can We Identify Patients at Risk?

Sanjit R Konda; Nicket Dedhia; Rachel A Ranson; Yixuan Tong; Abhishek Ganta; Kenneth A Egol

doi:10.1177/21514593211002158

Loss of Ambulatory Level and Activities of Daily Living at 1 Year Following Hip Fracture: Can We Identify Patients at Risk?

Geriatr Orthop Surg Rehabil. 2021 Mar 31:12:21514593211002158. doi: 10.1177/21514593211002158. eCollection 2021.

Authors

Sanjit R Konda^{1

2}, Nicket Dedhia¹, Rachel A Ranson¹, Yixuan Tong¹, Abhishek Ganta^{1

2}, Kenneth A Egol^{1

2}

Affiliations

¹ Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.
² Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY, USA.

Abstract

Introduction: Operative hip fractures are known to cause a loss in functional status in the elderly. While several studies exist demonstrating the association between age, pre-injury functioning, and comorbidities related to this loss of function, no studies have predicted this using a validated risk stratification tool. We attempt to use the Score for Trauma Triage for Geriatric and Middle-Aged (STTGMA) tool to predict loss of ambulatory function and need for assistive device use.

Materials and methods: Five hundred and fifty-six patients ≥55 years of age who underwent operative hip fracture fixation were enrolled in a trauma registry. Demographics, functional status, injury severity, and hospital course were used to determine a STTGMA score and patients were stratified into risk quartiles. At least 1 year after hospitalization, patients completed the EQ-5D questionnaire for functional outcomes.

Results: Two hundred and sixty-eight (48.2%) patients or their family members responded to the questionnaire. Of the 184 patients alive, 65 (35.3%) reported a return to baseline function. Eighty-nine (48.4%) patients reported a loss in ambulatory status. Patients with higher STTGMA scores were older, had more comorbidities, reported greater need for help with daily activities, increased difficulty with self-care, and a reduction in return to activities of daily living (all p ≤ 0.001). Patients with lower STTGMA scores were more likely to never require an assistive device while those with higher scores were more likely to continue needing one (p = 0.004 and p < 0.001). Patients in the highest STTGMA risk groups were 1.5x more likely to have an impairment in ambulatory status (need for ambulatory assistive device or decreased ambulatory capacity) (p = 0.004).

Discussion: Patients in higher STTGMA risk quartiles were more likely to experience impairment after hip fracture surgery. The STTGMA tool can predict loss of ambulatory independence following hip fracture. At-risk populations can be targeted for enhanced physiotherapy and rehabilitation services for optimal return to prior functioning.

Keywords: ambulatory independence; geriatric trauma; hip fracture; risk stratification; score for trauma triage in the geriatric and middle-aged (STTGMA).