Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study

Yu-Pin Chen; Yi-Jie Kuo; Chieh-Hsiu Liu; Pei-Chun Chien; Wei-Chun Chang; Chung-Ying Lin; Amir H Pakpour

doi:10.1177/1759720X211028360

Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study

Ther Adv Musculoskelet Dis. 2021 Jul 9:13:1759720X211028360. doi: 10.1177/1759720X211028360. eCollection 2021.

Authors

Yu-Pin Chen¹, Yi-Jie Kuo¹, Chieh-Hsiu Liu², Pei-Chun Chien¹, Wei-Chun Chang¹, Chung-Ying Lin³, Amir H Pakpour⁴

Affiliations

¹ Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei.
² Department of Geriatrics and Gerontology, Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan.
³ Institute of Allied Health Sciences and Departments of Occupational Therapy and Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701.
⁴ Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.

Abstract

Background: Hip fractures are a major public health concern among elderly individuals. This study aimed to investigate potential perioperative factors that predict 1-year functional outcome, quality of life (QoL), care demands, and mortality in geriatric patients with a hip fracture.

Methods: We prospectively enrolled geriatric patients who had undergone hip fracture surgery in one medical center from December 2017 to December 2019. Basic demographic data, handgrip strength, and responses to questionnaires for QoL and activities of daily living (ADL) before the injury were collected at baseline. QoL, ADL, additional care demands other than family support, and mortality events were monitored at 1 year after the operation.

Results: Among 281 patients with a hip fracture, 39 (13.9%) died within 1 year of the index operation. The mean follow-up interval for the survivors was 403.3 (range: 358-480) days. Among the 242 survivors, ADL and QoL considerably decreased at approximately 1 year following hip surgery. Up to 33.9% of the participants became severely dependent and needed additional care at 1-year follow up. Prefracture ADL status was the crucial predictor for functional outcome, QoL, and additional care demand at 1-year follow up. Cox regression models indicated that male sex, low preoperative serum creatinine, handgrip strength, long surgical delay after a falling accident, and high Charlson Comorbidity Index were considerably associated with a high 1-year mortality risk in the geriatric hip fracture population.

Conclusion: Hip fracture has long-lasting effects (e.g. functional loss, decline in QoL, increased care demands, and high postoperative mortality rate) on the geriatric population. A robust screening method must be developed for identifying potential prognostic factors, and a stratified care approach must be used that accounts for personalized risks to improve functional outcomes and reduce mortality after hip fracture in geriatric patients, especially in Taiwan.

Keywords: function; handgrip strength; hip fracture; mortality; quality of life.