Patient and Perioperative Factors Influencing the Functional Outcomes and Mortality in Elderly Hip Fractures

Abstract

This study aimed to evaluate the functional outcomes and mortality following hip fracture surgery in elderly patients, and to identify the associated risk factors. Between January 2016 and December 2017, 480 consecutive patients were finally included for data analyses. The Harris score and Barthel index were used to evaluate the hip function and ability to perform activities of daily living (ADL). Univariate and multivariate logistics regression analyses were performed to determine the independent risk factors for mortality, poor hip function or poor ability to perform ADL. The mortality rate was 15.6% (75/480). In the survivors, poor outcome developed in 133 (32.8%) patients and poor ADL was in 72 (17.8%) patients. The independent factors that influenced mortality were advanced age (p = 0.033), male gender (0.031), living in rural area (p < 0.001), self-reported diabetes (p = 0.005), tumor (p = 0.024), preoperative delay >7 days (p = 0.020), postoperative drainage use (p = 0.034), WBC > 10 × 10⁹/L (p = 0.005), reduced RBC (p = 0.011), PLT < 100 × 10⁹/L (p < 0.001), ALB < 35 g/L (p < 0.001) and CK > 200 U/L (p = 0.003). The independent factors that influenced the hip function were male gender (p = 0.009), WBC > 10 × 10⁹/L (p < 0.001), lower HBG (p = 0.005), and ALB < 35 g/L (p < 0.001). The independent factors that influenced the ability to perform ADL were diagnosis of trochanteric fracture (p = 0.048), preoperative delay > 7 days (p = 0.027), postoperative drainage use (p = 0.010), elevated WBC (p = 0.020), lower HGB (p < 0.001), PLT < 100 × 10⁹/L (p = 0.002), and ALB < 35 g/L (p < 0.001). Although most of risk factors were not modifiable, they aid in patient individual risk evaluation, risk stratification, and counseling patients or relatives.

Keywords:

• elderly
• hip fracture
• mortality
• activities of daily living
• hip function
• risk factors

Acknowledgements

We are grateful to J. Liu and Y. Zhu of the Department of Orthopedics, and to P. Du of the Department of Infection Control for their kind assistance. There is no funding source.

Additional information

Notes on contributors

Zhaohui Song

Zhaohui Song designed the study; Haotian Wu and Shuangquan Yao and Kaosheng Lu inquired the EMR and collected the preioperative data; Defei Ment and Xiaoyi Bai followed up the patients; Xiaodong Bai and Chongyao Lu seared the relevant literature and analyzed the data. Defei Meng and Xiaoyi Bai wrote the manuscript and Zhaohui Song approved the final manuscript.