Prediction of Mortality in Elderly Patients with Hip Fractures: A Two-Year Prospective Study of 1,944 Patients

Söderqvist, Anita; Ekström, Wilhelmina; Ponzer, Sari; Pettersson, Hans; Cederholm, Tommy; Dalén, Nils; Hedström, Margareta; Tidermark, Jan

doi:10.1159/000230587

Cited by 125 publications

(88 citation statements)

References 47 publications

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“…Elderly patients who died at 1 or 2 years after femoral neck fracture had a higher modified frailty index when compared with those who lived. Our results support the association of mortality and frailty demonstrated by other studies in multiple settings [12,13,21]. The modified frailty index appears to be a useful tool to predict mortality at 1 and 2 years status postfemoral neck fracture.…”

Section: Discussionsupporting

confidence: 90%

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Patel

Brennan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

136

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Background Frailty, a multidimensional syndrome entailing loss of energy, physical ability, cognition, and health, plays a significant role in elderly morbidity and mortality. No study has examined frailty in relation to mortality after femoral neck fractures in elderly patients. Questions/purposes We examined the association of a modified frailty index abbreviated from the Canadian Study of Health and Aging Frailty Index to 1-and 2-year mortality rates after a femoral neck fracture. Specifically we examined: (1) Is there an association of a modified frailty index with 1-and 2-year mortality rates in patients aged 60 years and older who sustain a low-energy femoral neck fracture? (2) Do the receiver operating characteristic (ROC) curves indicate that the modified frailty index can be a potential tool predictive of mortality and does a specific modified frailty index value demonstrate increased odds ratio for mortality? (3) Do any of the individual clinical deficits comprising the modified frailty index independently associate with mortality? Methods We retrospectively reviewed 697 low-energy femoral neck fractures in patients aged 60 years and older at our Level I trauma center from 2005 to 2009. A total of 218 (31%) patients with high-energy or pathologic fracture, postoperative complication including infection or revision surgery, fracture of the contralateral hip, or missing documented mobility status were excluded. The remaining 481 patients, with a mean age of 81.2 years, were included. Mortality data were obtained from a state vital statistics department using date of birth and Social Security numbers. Statistical analysis included unequal variance t-test, Pearson correlation of age and frailty, ROC curves and area under the curve, Hosmer-Lemeshow statistics, and logistic regression models. Results One-year mortality analysis found the mean modified frailty index was higher in patients who died (4.6 ± 1.8) than in those who lived (3.0 ± 2; p \ 0.001), which was maintained in a 2-year mortality analysis (4.4 ± 1.8 versus 3.0 ± 2; p\0.001). In ROC analysis, the area under the curve was 0.74 and 0.72 for 1-and 2-year mortality, respectively. Patients with a modified frailty index of 4 or greater had an odds ratio of 4.97 for 1-year mortality and an odds ratio of 4.01 for 2-year mortality as compared with patients with less than 4. Logistic regression models demonstrated that the clinical deficits of mobility, respiratory, renal, malignancy, thyroid, and impaired cognition were independently associated with 1-and 2-year mortality. Conclusions Patients aged 60 years and older sustaining a femoral neck fracture, with a higher modified frailty index, had increased 1-and 2-year mortality rates, and the ROC Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of...

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Section: Discussionsupporting

confidence: 90%

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Patel

Brennan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

136

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“…No studies were identified from Africa and only a few included from South East Asia or South America. We did not attempt to analyse findings by gender, although most studies included more than three quarters women and it is known that mortality rates are higher for men than women [45,56,57]. Pooling of study outcomes was not performed due to the wide variation in the type and reporting of outcomes used.…”

Section: Discussionmentioning

confidence: 99%

A Critical Review of the Long-Term Disability Outcomes Following Hip Fracture

Dyer

Crotty

Fairhall

et al. 2017

Innovation in Aging

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Background: Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. This review aims to quantify the impact of hip fracture on older people's abilities and quality of life over the long term. Methods: Studies were identified through PubMed and Scopus searches and contact with experts. Cohort studies of hip fracture patients reporting outcomes 3 months post-fracture or longer were included for review. Outcomes of mobility, participation in domestic and community activities, health, accommodation or quality of life were categorised according to the World Health Organization's International Classification of Functioning and synthesised narratively. Risk of bias was assessed according to four items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results: Thirty-eight studies from 42 publications were included for review. Most followed a clearly defined sample from the time of fracture. Hip fracture survivors experienced significantly worse mobility, independence in function, health, quality of life and higher rates of institutionalisation than age matched controls. The bulk of recovery of walking ability and activities for daily living occurred within 6 months after fracture. Between 40 and 60 % of study participants recovered their pre-fracture level of mobility and ability to perform instrumental activities of daily living, while 40-70 % regained their level of independence for basic activities of daily living. For people independent in self-care pre-fracture, 20-60 % required assistance for various tasks 1 and 2 years after fracture. Fewer people living in residential care recovered their level of function than those living in the community. In Western nations, 10-20 % of hip fracture patients are institutionalised following fracture. Few studies reported impact on participation in domestic, community, social and civic life.

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“…Certain variables were collected as measures of preoperative medical status, including the American Society of Anesthesiologists Physical Status (ASA PS) grade (1-6) [35], preoperative hemoglobin, cigarette smoking status, and body mass index (BMI), including those patients meeting obesity criteria (BMI C 30 kg/m 2 ). The ASA PS classification system is used to assess the fitness of a patient for surgery before beginning anesthesia and consists of six categories (PS 1: normal, healthy patient; PS 2: patient with mild, systemic disease; PS 3: patient with severe, systemic disease; PS 4: patient with severe, systemic disease that is a constant threat to life; PS 5: moribund patient who is not expected to survive without the operation; PS 6: brain-dead patient whose organs are being removed for donor purposes) [35].…”

Section: Methodsmentioning

confidence: 99%

Total Shoulder Arthroplasty in Older Patients: Increased Perioperative Morbidity?

Ricchetti

Abboud

Kuntz

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background More elderly patients are becoming candidates for total shoulder arthroplasty with an increase in frequency of the procedure paralleling the rise in other total joint arthroplasties. Controversy still exists, however, regarding the perioperative morbidity of total joint arthroplasty in elderly patients, particularly those 80 years of age and older. Questions/purposes We asked whether perioperative complications and mortality, transfusion requirements, inpatient length of stay, and discharge disposition after total shoulder arthroplasty were similar in patients 80 years and older compared with those in younger patients. MethodsWe retrospectively compared the 90-day complications, mortality, and other perioperative variables after total shoulder arthroplasty in 40 patients (43 shoulders) aged 80 years and older (Group A; mean age, 82 years) with 46 patients (47 shoulders) younger than 70 years (Group B; mean age, 61 years). Results We found no differences in complication rates between Group A and B, including systemic (26% versus 11%) and local (5% versus 9%) complications or major (7% versus 2%) and minor (23% versus 17%) complications. There were no deaths in either group. Group A had an increased transfusion requirement (16% versus 2%) and a decreased number of direct to home discharges (67% versus 98%

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Prediction of Mortality in Elderly Patients with Hip Fractures: A Two-Year Prospective Study of 1,944 Patients

Cited by 125 publications

References 47 publications

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

A Critical Review of the Long-Term Disability Outcomes Following Hip Fracture

Total Shoulder Arthroplasty in Older Patients: Increased Perioperative Morbidity?

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