Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study

Yoon, Soo Hoon; Kim, Bo Ryun; Lee, Sang Yoon; Beom, Jaewon; Choi, Jun Hwan; Lim, Jae‐Young

doi:10.1186/s12877-021-02227-5

Cited by 24 publications

(21 citation statements)

References 44 publications

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“…Yoon et al [60] found that diabetes negatively affected a variety of functional outcomes, including not only K-IADL and also the FAC, EQ-5D, K-FRAIL, and geriatric depression scale related to depression. Lieberman et al [61] concluded that the rehabilitation outcome of diabetic patients was significantly worse than that of non-diabetic patients among older patients with hip fractures using the FIM scale.…”

Section: Discussionmentioning

confidence: 99%

Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture: A retrospective cohort study

Kang¹,

Kim²,

Lee³

et al. 2023

Medicine

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To determine the predictors of functional outcomes and quality of life (QoL) of patients who were surgically treated for fragility hip fracture. This was a retrospective cohort study performed in the 3 tertiary rehabilitation facilities. A total of 165 patients who had undergone surgery for fragility hip fracture were followed up to 6 months postoperatively. The factors expected to be related to the functional outcomes and QoL at 6 months post-surgery were as follows: baseline demographics, fracture site, operation type, fall characteristics including fall location and fall direction, comorbidities, and initial functional status. The following were comorbidities: hypertension, diabetes mellitus, dementia, cerebrovascular accident, and osteoporosis. Functional outcome and QoL measures were represented using the Koval grade, functional ambulatory category (FAC), Berg balance scale, 4-m walking speed test, the Korean version of Mini-Mental State Examination, EuroQol 5-dimension (EQ-5D) questionnaire, the Korean version of Modified Barthel Index, and the Korean version of instrumental activities of daily living (K-IADL). For all tests, each patient was assessed immediately after transfer and at 6 months post-surgery. Multivariable regression analyses adjusting for factors mentioned above were as follows. Old age led to a significantly less favorable outcome on FAC and K-IADL at 6 months. Intertrochanteric fracture had a significantly positive impact on Koval at 6 months compared to femur neck and intertrochanteric fractures. Total hip replacement arthroplasty and bipolar hemiarthroplasty had a significantly positive impact on EQ-5D and FAC at 6 months respectively compared to other operation types. Fall characteristics didn’t reveal any significant impact on functional outcomes and QoL. Patients with hypertension and diabetes mellitus had a significantly negative outcome on EQ-5D and K-IADL respectively. Among initial assessments of function and QoL, initial 4-m walking speed test, Korean version of Mini-Mental State Examination, K-IADL, and Korean version of Modified Barthel Index were independent predictors of function and QoL at 6 months. This study confirmed that age, fracture site, operation type, comorbidities, and initial physical and cognitive function significantly influenced recovery of function and QoL at 6 months in patients with fragility hip fractures.

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Section: Discussionmentioning

confidence: 99%

Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture: A retrospective cohort study

Kang¹,

Kim²,

Lee³

et al. 2023

Medicine

Self Cite

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“…HTN can influence pulmonary circulation, whereas liver disease and COPD can negatively influence the immune response to environmental pathogens in a hospital or community setting; all of these factors can increase the vulnerability of older patients to respiratory infection, especially during the acute period around surgery. These comorbidity factors can also negatively influence the functional recovery of older patients with fractures and indirectly cause acute respiratory problems when the recovery of the lower extremities is slow [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Acute Respiratory Infection Was Higher in the Older Adults with Lower Limb Fracture Who Receive Spinal Anesthesia Than Those Who Receive General Anesthesia

Yeh

Lee

et al. 2022

IJERPH

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Introduction: Acute respiratory infection (ARI) can significantly reduce postoperative quality of life and impair the recovery of older adult patients with lower-limb fractures, and its relationship with methods of anesthesia remains inconclusive. Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, this study examined the data of patients who received surgical management for lower-limb fractures and compared those who underwent general anesthesia (GA) with those who underwent regional anesthesia (RA) in terms of their incidence of acute upper and lower respiratory infection during the one-month postoperative period. The study also identified related risk factors. Material and Methods: Approximately two million patients were randomly sampled from the NHIRD registry. We identified and enrolled patients with lower-limb fractures who were over 60 years old and underwent GA or RA during surgeries conducted between 2010 and 2017. We divided these patients into two groups for further analysis. The outcome of this study was the development of ARI during the one-month postoperative period. Results: In total, 45,032 patients (GA group, 19,580 patients; RA group, 25,452 patients) with a mean age of 75.0 ± 8.9 years were included in our study. The incidence of postoperative ARI within one month of surgery was 8.0% (1562 patients) in the GA group and 9.5% (2412 patients) in the RA group, revealing a significant difference. The significant risk factors for the incidence of ARI were the application of RA for surgery, older age, hypertension, liver disease, and chronic obstructive pulmonary disease (COPD). A subgroup analysis revealed that the RA method was associated with a significantly higher ARI incidence relative to the GA method among patients aged between 60 and 80 years, among male patients, among the patients with or without any comorbidity and among the patients without COPD. Conclusion: The incidence of postoperative ARI within one month of surgery was higher among older patients with lower-limb fractures who received RA for surgery than among those who received GA for surgery. The other major risk factors for ARI were older age, hypertension, liver disease, and COPD. Therefore, we should focus on patients with a high risk of developing ARI, especially during the COVID-19 pandemic.

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“…It is noteworthy to note that 75% of patients do not die due to the pathology of the hip fracture itself, but rather as a consequence of a comorbidity prior to the injury [31]. Yoon et al have shown that dementia and DM have a signi cant effect on postoperative functional outcomes [32]. Anemia will increase hospital complications as well as hospitalization costs [33].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Comparison of Osteoporotic Hip Fractures in Spain and China: A Multicenter Study

Gao¹,

Capitan-Morales

Wang³

et al. 2021

Preprint

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Objective Compare the epidemiological differences of hip fracture patients in Spain and China. Materials and Method This was a retrospective study. The study population came from patients with hip fractures who underwent surgery between January 1, 2017 and December 30, 2017 at the University Hospital Virgen Macarena (UHVM) in Seville, Spain and Xi’an Daxing Hospital (XDH) in Shaanxi Province, China. Through medical history review and telephone follow-up, the differences of demographic and anthropometric characteristics, lifestyle, personal medical history, variables related to injury, anesthesia, and surgery, length of stay in hospital, days of bed rest, and mortality of patients in the two hospitals were compared. Results A total of 757 patients were enrolled, of which 426 were from UHVM and 331 were from XDH. The average age was 81.4±9.26 years and 76.0±8.08 years, respectively; the male and female distribution was 25.1% and 74.9% vs. 32.0% and 68.0%. The average BMI of Spanish patients was higher than that of Chinese patients. The proportion of drinking and smoking among Spanish patients was significantly higher than that of Chinese patients (p = 0.000, p = 0.000, respectively). The proportion of patients with ≥ 3 comorbidities in Spain was higher than that in China (p = 0.002). The surgery delay time of Spanish patients was significantly longer than that of Chinese patients (p = 0.000). Spanish patients had a shorter hospital stay, but a longer time in bed. During the one-year follow-up, there were 81 deaths in Spain and 43 deaths in China (p = 0.026). Conclusiones There are large epidemiological differences between hip fracture patients in Seville, Spain and Xi'an, China in terms of demographics, lifestyle, comorbidities, surgical methods, and mortality.

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Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study

Cited by 24 publications

References 44 publications

Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture: A retrospective cohort study

Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture: A retrospective cohort study

The Incidence of Acute Respiratory Infection Was Higher in the Older Adults with Lower Limb Fracture Who Receive Spinal Anesthesia Than Those Who Receive General Anesthesia

Epidemiological Comparison of Osteoporotic Hip Fractures in Spain and China: A Multicenter Study

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