The basic mobility status upon acute hospital discharge is an independent risk factor for mortality up to 5 years after hip fracture surgery

Figures & data

Figure 1. Kaplan–Meier graph of 1-year (grey vertical line) and 5-year post-surgical survival of patients independent in basic mobility (CAS =6, blue line) and not (CAS <6, red line) on acute hospital discharge.

Table 1. Characteristics and 1-year mortality: values are mean (SD) for age and median (IQR) for the length of stay; otherwise, number (%)

		Alive 1-year post-surgery
	All patients	Yes	No
Variables	n = 444	n = 373 (84)	n = 71 (16)	p-value
Age, years	81.4 (8.5)	81.2 (8.5)	82.9 (8.0)	0.1
Men	103 (23)	80 (78)	23 (22)	0.05
Women	341 (77)	293 (86)	48 (14)
New Mobility Score 2–4 points	156 (35)	116 (74)	40 (26)	< 0.001
New Mobility Score 5–9 points	288 (65)	257 (89)	31 (11)
Low cognitive status	86 (19)	68 (79)	18 (21)	0.2
High cognitive status	358 (81)	305 (85)	53 (15)
ASA grade 1–2	244 (55)	219 (90)	25 (10)	< 0.001
ASA grade 3–4	200 (45)	154 (77)	46 (23)
Femoral neck fracture	225 (51)	196 (87)	29 (13)	0.07
Trochanteric fracture^a	219 (49)	177 (81)	42 (19)
2 screws/nails	60 (15)	58 (97)	2 (3)	0.1
Hemiarthroplasty	139 (31)	115 (83)	24 (17)
Total arthroplasty	6 (1)	6 (100)	n/a
Dynamic Hip Screw with 2-hole plate	18 (4)	15 (83)	3 (17)
Dynamic Hip Screw with 4-hole plate	179 (40)	145 (81)	34 (19)
Short intramedullary hip screw	24 (5)	20 (83)	4 (17)
Long intramedullary hip screw	18 (4)	14 (78)	4 (22)
Discharged to previous residence	331 (75)	289 (87)	42 (13)	0.001
Not discharged to previous residence	113 (25)	84 (74)	29 (26)
Length of stay, post-surgery	13 (9–20)	13 (9–18)	18 (12–29)	< 0.001
Cumulated Ambulation Score =6 ^b	342 (77)	302 (88)	40 (12)	< 0.001
Cumulated Ambulation Score <6	102 (23)	71 (70)	31 (30)

a Includes 12 subtrochanteric fractures.

b A score of 6 equals independent basic mobility status on hospital discharge.

Table 2. Multivariable Cox regression analysis of risk factors of mortality within 1 and 5 years after hip fracture surgery, n = 444

	1-year adjusted		5-year adjusted
Risk factors	HR (95% CI)	p-value	HR (95% CI)	p-value
60–69 years of age	Reference
70–79 years of age	1.1 (0.4–3.3)	0.8	1.1 (0.7–2.0)	0.6
80–89 years of age	1.9 (0.7–4.9)	0.2	1.8 (1.1–3.0)	0.02
90 years and older	1.5 (0.5–4.5)	0.4	2.1 (1.2–3.7)	0.01
Women	Reference
Men	2.1 (1.3–3.6)	0.005	1.5 (1.1–2.0)	0.01
NMS 2–9 (continuous) ^a	0.87 (0.77–0.97)	0.01	0.89 (0.84–0.94)	< 0.001
High cognitive status	Reference
Low cognitive status	0.93 (0.53–1.6)	0.8	0.94 (0.69–1.3)	0.7
ASA grade 1–4 (continuous)	1.5 (0.98–2.3)	0.07	1.5 (1.2–1.9)	< 0.001
Femoral neck fracture	Reference
Trochanteric fracture^b	1.2 (0.7–2.0)	0.4	0.97 (0.74–1.3)	0.8
Cumulated Ambulation Score =6^c	Reference
Cumulated Ambulation Score <6	1.8 (1.1–3.2)	0.04	1.5 (1.1–2.0)	0.03

a NMS: New Mobility Score, high scores indicate high pre-fracture functional level.

b Includes 12 subtrochanteric fractures.

c A score of 6 equals independent basic mobility status on hospital discharge.

Figure 2. Distribution of CAS scores: 0 = cannot, 1 = can with assistance/guiding, and 2 = can independent of human assistance for each of the 3 CAS activities, at time of hospital discharge, for the 102 patients not reaching independence in the total CAS =6 points.

Figure 3. Kaplan–Meier graph of 1-year post-discharge survival of patients according to post-surgery length of hospital stay (LOS).