Pre-fracture hospitalization is associated with worse functional outcome and higher mortality in geriatric hip fracture patients.

Abstract

The influence of a pre-fracture hospitalization on outcomes in hip fracture patients has not yet been investigated. Four hundred two patients who were surgically treated for hip fracture were prospectively enrolled. Patients with a hospital stay within the last 3months prior to a hip fracture were compared to patients without a pre-fracture hospitalization. Postoperative functional outcomes and mortality rates were compared between groups at the time of hospital discharge and additionally at the six- and twelve-month follow-up appointments. A multivariate regression analysis was performed. A pre-fracture hospitalization was reported by 67 patients (17%). In 63% of cases, patients were admitted due to non-surgical, general medical conditions. In 37% of cases, patients were treated due to a condition related to a surgical subject. In the multivariate analysis, pre-fracture hospitalization was an independent risk factor for reduced values on the Barthel Index at 6months after surgery (B, -9.918; 95%CI of B, -19.001--0.835; p=0.032) and on the Tinetti Test at 6months (B, -2.914; 95%CI of B, -1.992--0.047; p=0.047) and 12months after surgery (B, -4.680; 95%CI of B, -8.042--1.319; p=0.007). Pre-fracture hospitalization was additionally associated with increased mortality rates at 6months (OR 1.971; 95%CI 1.052-3.693; p=0.034) and 12months after surgery (OR 1.888; 95%CI 1.010-9.529; p=0.046). Hip fracture patients with a recent pre-fracture hospital admission are at a substantial risk for inferior functional outcomes and increased mortality rates not only in the perioperative phase but also in the first postoperative year. As a simple dichotomous variable, pre-fracture hospitalization might be a suitable tool for future geriatric hip fracture screening instruments.