Trends in Patient-Reported Physical Function After Hip Fracture Surgery

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Aug 15

PMID 39144900

Authors

Parimal Rana

Jane C Brennan

Andrea H Johnson

Paul J King

Justin J Turcotte

Affiliations

Soon will be listed here.

Abstract

Background Hip fractures carry significant morbidity and mortality, yet studies assessing post-surgical functional recovery from the patient's perspective are scarce, lacking benchmarks against age-matched populations. This study aimed to identify factors influencing postoperative functional outcomes, compared to the lower 25th percentile of normal age-matched populations, and to compare postoperative physical function with one-year mortality following hip fracture surgery. Methodology A retrospective review of 214 hip fracture patients reporting to the emergency department (ED) from July 2020 to June 2023 was conducted, with all completing a three-month postoperative Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) survey. Primary outcomes included three-month PROMIS-PF scores, with secondary outcomes focusing on one-year mortality. Factors such as demographics, comorbidities, procedures, time to surgery, length of stay, and postoperative outcomes were analyzed for correlation. Multivariate logistic regression assessed predictors of achieving a PROMIS-PF T-score of at least 32.5, representing the bottom 25th percentile for age-matched populations, and the relationship between three-month PROMIS PF T-scores and one-year mortality. Results Surgery was performed within 24 hours of ED arrival in 118 (55.1%) patients, the average length of stay was 5.2 days, and 64 (29.9%) were discharged home. Total hip arthroplasty and home discharge correlated with higher physical function scores. In contrast, older age, higher American Society of Anesthesiologists scores, certain comorbidities, specific surgical procedures, and longer hospital stays were associated with lower scores. Fewer than half (102 [47.7%]) achieved functional levels comparable to the 25th percentile of age-matched populations. Multivariate analysis indicated chronic obstructive pulmonary disease and home discharge as predictors of achieving this threshold, while higher PROMIS-PF T-scores were associated with reduced one-year mortality. Conclusions Patients undergoing hip fracture surgery are unlikely to achieve high levels of physical function within the three-month postoperative period. Fewer than half of these patients will reach functional levels, and decreased early function is associated with an increased risk of one-year mortality.

References

Darbandi A, Saadat G, Alsoof D, Rebic A, Siddiqi A, Butler B . Effects of Delayed Hip Fracture Surgery on Severely Ill Patients: Defining the Time to Medical Optimization. Am Surg. 2022; 89(5):1864-1871. DOI: 10.1177/00031348221080425. View

Ekegren C, Edwards E, Page R, Hau R, de Steiger R, Bucknill A . Twelve-month mortality and functional outcomes in hip fracture patients under 65 years of age. Injury. 2016; 47(10):2182-2188. DOI: 10.1016/j.injury.2016.05.033. View

Mannion A, Nauer S, Arsoy D, Impellizzeri F, Leunig M . The Association Between Comorbidity and the Risks and Early Benefits of Total Hip Arthroplasty for Hip Osteoarthritis. J Arthroplasty. 2020; 35(9):2480-2487. DOI: 10.1016/j.arth.2020.04.090. View

Larsson G, Stromberg U, Rogmark C, Nilsdotter A . It was not a hip fracture - you were lucky this time - or perhaps not! A prospective study of clinical outcomes in patients with low-energy pelvic fractures and hip contusions. Injury. 2019; 50(4):913-918. DOI: 10.1016/j.injury.2019.03.021. View

Melamed R, Boland L, Normington J, Prenevost R, Hur L, Maynard L . Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes. Perioper Med (Lond). 2016; 5:19. PMC: 4969722. DOI: 10.1186/s13741-016-0044-1. View

Liu S, Qiang L, Yang Q, Fan L, Wang J, Yang Y . Delayed surgery is associated with adverse outcomes in patients with hip fracture undergoing hip arthroplasty. BMC Musculoskelet Disord. 2023; 24(1):286. PMC: 10100473. DOI: 10.1186/s12891-023-06396-9. View

Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B . The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care. 2007; 45(5 Suppl 1):S3-S11. PMC: 2829758. DOI: 10.1097/01.mlr.0000258615.42478.55. View

Kane R, Chen Q, Finch M, Blewett L, Burns R, Moskowitz M . Functional outcomes of posthospital care for stroke and hip fracture patients under medicare. J Am Geriatr Soc. 1998; 46(12):1525-33. DOI: 10.1111/j.1532-5415.1998.tb01537.x. View

Yakubek G, Curtis G, Sodhi N, Faour M, Klika A, Mont M . Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Hip Arthroplasty. J Arthroplasty. 2018; 33(6):1926-1929. DOI: 10.1016/j.arth.2017.12.043. View

10.

Xu B, Yan S, Low L, Vasanwala F, Low S . Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord. 2019; 20(1):568. PMC: 6882152. DOI: 10.1186/s12891-019-2950-0. View

11.

Haslam-Larmer L, Donnelly C, Auais M, Woo K, DePaul V . Early mobility after fragility hip fracture: a mixed methods embedded case study. BMC Geriatr. 2021; 21(1):181. PMC: 7962231. DOI: 10.1186/s12877-021-02083-3. View

12.

Eastwood E, Magaziner J, Wang J, Silberzweig S, Hannan E, Strauss E . Patients with hip fracture: subgroups and their outcomes. J Am Geriatr Soc. 2002; 50(7):1240-9. DOI: 10.1046/j.1532-5415.2002.50311.x. View

13.

Doruk H, Mas M, Yildiz C, Sonmez A, Kyrdemir V . The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr. 2004; 39(2):179-85. DOI: 10.1016/j.archger.2004.03.004. View

14.

Orosz G, Magaziner J, Hannan E, Morrison R, Koval K, Gilbert M . Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004; 291(14):1738-43. PMC: 1454713. DOI: 10.1001/jama.291.14.1738. View

15.

Braithwaite R, Col N, Wong J . Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003; 51(3):364-70. DOI: 10.1046/j.1532-5415.2003.51110.x. View

16.

Guzon-Illescas O, Perez Fernandez E, Crespi Villarias N, Quiros Donate F, Pena M, Alonso-Blas C . Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019; 14(1):203. PMC: 6610901. DOI: 10.1186/s13018-019-1226-6. View

17.

Vestergaard P, Rejnmark L, Mosekilde L . Has mortality after a hip fracture increased?. J Am Geriatr Soc. 2007; 55(11):1720-6. DOI: 10.1111/j.1532-5415.2007.01420.x. View

18.

Burns A, Younger J, Morris J, Baldwin R, Tarrier N, Pendleton N . Outcomes following hip fracture surgery: a 2-year prospective study. Am J Geriatr Psychiatry. 2013; 22(8):838-44. DOI: 10.1016/j.jagp.2013.01.047. View

19.

Li S, Sun T, Liu Z, Ren J, Liu B, Gao Y . Factors influencing postoperative mortality one year after surgery for hip fracture in Chinese elderly population. Chin Med J (Engl). 2013; 126(14):2715-9. View

20.

OHara N, Richards J, Overmann A, Slobogean G, Klazinga N . Is PROMIS the new standard for patient-reported outcomes measures in orthopaedic trauma research?. Injury. 2019; 51 Suppl 2:S43-S50. DOI: 10.1016/j.injury.2019.10.076. View