Background Hip fracture determines a high morbimortality in old population.
Objectives To analyze the determinants of morbimortality in patients with hip fracture.
Methods From March 1, 2009 to December 31, 2010, all patients admitted with osteoporotic hip fracture in a university hospital, were visited in a prospectively and formalized way, variables were entered in a database. We collected socio-demographic, clinical and analytical data concerning the patient’s status before the fracture, complications arising during admission and phone follow-up (performed after 3 months and after one year). We analyzed which variables were associated with cognitive and functional recovery and mortality. We assumed that there would be functional recovery if one of these premises were met: positive opinion from the patient or family, no deterioration of the Barthel index (BI) (minimum significant change: 15 points) and maintenance of walking ability (self moving ability, a support, walker, wheelchair). We assumed there was cognitive recovery when the opinion of the patient or the family was positive and showed no deterioration in the category of the Pfeiffer test.
Results We included 425 patients (72% women) with mean age 83±8 years. On admission, the body mass index (BMI) was 25,7±4,8 kg/m2. The Charlson comorbidity index (CI) medium was 1,7±2 and IB, 76±29 points. Pfeiffer’s test was normal in 57% of patients and showed mild, moderate or severe decline in 16%, 14% and 13% respectively.The mean number of currently taken drugs was 6±5.
Regarding laboratory parameters, mean haemoglobin was 11,8±1,9 g/dL, serum creatinine, 98±72 mmol/L (normal renal function in 65% of patients, estimated by the creatinine clearance), albumine, 31,4±4,3 g/L. With respect to the parameters of bone metabolism, a calcidiol serum level of 29.2±24,7 nM/L stands out.
Seven percent of the patients died during hospitalization, 9% before the 3 months and 9% during the first year. Statistically significant factors associated with higher mortality were: male gender, older age, lower BMI, worse IC, IB and Pfeiffer test, higher drugs use, hypovitaminosis D, worse renal function and lower concentrations of serum albumin and haemoglobin. The type of fracture or surgical intervention was not associated with mortality. In surviving patients, the frequency of functional recovery after 3 months and after one year was 63% and 61% respectively (p: ns). Cognitive recovery was 35% and 36% respectively (p: ns). Statistically significant variables that determined the absence of functional recovery were older age and lower calcidiol and serum albumin. A lower cognitive recovery was determined by older age, worse IB and worse Pfeiffer test.
Conclusions Patients with hip fractures present a high mortality. On admission, predictors of morbidity and mortality were the age, prior comorbidity and factors related with previous worse functional and cognitive status.
Disclosure of Interest None Declared