Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand

Abstract

An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients’ outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes.

Correlation between preoperative CT scan of the paraspinal, psoas, and gluteus muscles and postoperative ambulatory status in patients with femoral neck fractures

“…Regarding the relationship between femoral neck fractures and sarcopenia, the American Society of Anesthesiologists Physical Status classification system was reported as an independent prognostic factor [ 1 , 16 ].…”

Correlation between preoperative CT scan of the paraspinal, psoas, and gluteus muscles and postoperative ambulatory status in patients with femoral neck fractures

“…Regarding the relationship between femoral neck fractures and sarcopenia, the American Society of Anesthesiologists Physical Status classi cation system was reported as an independent prognostic factor [15,16].…”

Clinical Score for Predicting the Risk of Poor Ambulation at Discharge in Fragility Femoral Neck Fracture Patients: A Development Study

“…We estimated the sample size required for developing the multivariable clinical risk score using methods suggested by Riley et al [ 36 ]. Assuming that the number of significant candidate predictors from the univariable analysis was 15 and estimating the concordance statistics to be 0.85 and the average incidence of the outcome to be 20% based on our previous report [ 12 ], a minimum sample size of 460 with 92 events was needed. Achieving this target sample size would guarantee a 0.05 acceptable difference in apparent and adjusted R-squared, a 0.05 margin of error in the estimation of intercept, and an optimal number of events per predictor.…”

“…The intensive rehabilitation program should only focus on patients who are unlikely to achieve adequate ambulation within their hospital stays. Our previous study in patients with fragility hip fractures reported prognostic factors that were predictive of the inability to self-ambulate at discharge, such as patients with significant comorbidities, impaired baseline ambulatory status, associated fractures, and pressure ulcers [ 12 ]. Recognizing these factors during patient evaluation could potentially help clinicians to identify patients at risk of poor ambulatory status at discharge; however, this approach does not consider the multivariable nature of clinical prediction and does not provide estimations of the individual probability of poor ambulation.…”