Inpatient Rehabilitation Outcome After Hip Fracture Surgery in Elderly Patients: A Prospective Cohort Study of 946 Patients

Abstract

Lieberman D, Friger M, Lieberman D. Inpatient rehabilitation outcome after hip fracture surgery in elderly patients: a prospective cohort study of 946 patients. Objective To identify the factors associated with inpatient rehabilitation outcome after surgical repair of hip fracture in elderly patients. Design A noninterventional prospective cohort study. Setting Geriatric inpatient rehabilitation center in a tertiary university medical center in southern Israel. Participants Patients (N=946) aged 65 years of age or older who were hospitalized for rehabilitation after surgery for hip fracture. Interventions Not applicable. Main Outcome Measures Functional studies by the FIM instrument and a broad spectrum of clinical, demographic, and social variables. Stepwise multiple regression was used to assess the relative contribution of the variables to the variance of the percentage change in the FIM score during the course of rehabilitation in relation to the severity of the functional impairment at its inception. Results Eight variables were significantly and independently associated with rehabilitation outcome. Prefracture FIM scale (standardized regression coefficient in multiple regression [β]=.261, P<.001), serum albumin at discharge (β=.222, P<.001), Folstein Mini-Mental State Examination (β=.174, P<.001), visual impairment (β=−.089, P=.002), dyspnea at mild exertion (New York Heart Association class III) (β=−.080, P=.005), age (β=−.080, P=.007), poststroke motor impairment (β=−.072, P=.011), and decreased serum folic acid (β=−.055, P=.047). The total percentage of the explained variance of the primary rehabilitation outcome measure accounted for by these 8 variables (adjusted R 2) was 31.9%. Conclusions The outcome of rehabilitation of elderly patients after surgical repair of hip fracture is associated with 4 clinical and nutritional correctable parameters. The other 4 variables that are associated with the process cannot be corrected but may help predict outcomes and adjust expectations.