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THU0378 Predictors of One-Year Mortality in Elderly Hip Fracture Patients
  1. E. Dubljanin Raspopovic1,
  2. U. Nedeljkovic2,
  3. S. Tomanovic1,
  4. M. Bumbasirevic3
  1. 1Clinic for Physical Medicine and Rehabilitaiton, Clinical Center Serbia
  2. 2Clinical Center Serbia
  3. 3Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia, Belgrade, Serbia

Abstract

Background There is growing evidence that devastating consequences of hip fracture can possibly be counteracted with multidisciplinary inpatient rehabilitation3. Recognition of variables that influence mortality at an early stage is needed in order to set realistic rehabilitation goals, adequately allocate rehabilitation resources, and optimize recovery after hip fracture. The most frequently reported predictors of mortality after hip fracture are male gender, advanced age and poor general health status 4,5. However, data on potential predictive value of early functional outcome after hip fracture has not been sufficiently investigated.6

Objectives 1) to explore predictive factors of functional level at discharge 2) to assess 1-year mortality, and 3) to evaluate the impact of early functional outcome on 1-year mortality in patients operated on for hip fractures

Methods A total of 228 consecutive patients (average age 77.59±7.36)with hip fracture who met the inclusion criteria were enrolled in the study. Functional level at discharge was measured with motor FIM score. Mortality rates in the study population were calculated in absolute numbers, and as the standardised mortality ratio (SMR). Multivariate regression analysis was used to explore predictive factors for motor FIM at discharge, and 1-year mortality adjusted on important baseline variables.

Results Age, health status, cognitive level, pre-injury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1 year follow-up, 57 patients (25.0%; 43 women and 14 men) died. The all-cause mortality rate observed in this group was higher in all age groups, and in both genders when compared to all-cause mortality of general population (p<0.001). Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture;(HR=0.90, 95% CI=0.87-0.92; p<0.000).

Conclusions Functional level at discharge is the main determinant of long-term mortality in hip fracture patients. Motor-FIM score at discharge is a reliable predictor of mortality, and can be recommended for wide clinical use.

References

  1. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55:M498-507

  2. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002; 359:1929-1936.

  3. Handoll HH, Cameron ID, Mak JC, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2009;CD007125.

  4. Soderqvist A, Ekstrom W, Ponzer S, Pettersson H, Cederholm T, Dalen N, Hedstrom M, Tidermark J. Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology. 2009;55:496-504.

  5. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374.

  6. Alegre-Lopez J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernandez-Melon J. Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int. 2005;16:729-736.

Disclosure of Interest None Declared

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