Pre-fracture mobility is an independent predictor of post-operative outcomes in hip fracture surgery

ABSTRACT NUMBER: NESTAC MEDAL FOR MEDICAL STUDENTS_7

 

AUTHOR
Thomas Stubbs

MAIN ABSTRACT TEXT

Introduction
Hip fracture is the most common serious injury in the older population of the UK, and its incidence continues to rise. Previous studies have used preoperative patient characteristics to predict post-operative outcomes, but mobility, a key indicator of pre-operative function, has been largely neglected as a predictor of post-operative outcomes.

Methods
We analysed prospectively collected data from patients undergoing hip fracture surgery at a large-volume regional orthopaedic trauma centre. Pre-fracture mobility was defined as; mobile outdoors without aids, mobile outdoors with aids, indoor mobility with aids and no mobility. Post-operative outcomes studied were mortality and residence at 30-days of surgery, medical complications within 30- or 60-days of surgery (venous thromboembolism, arterial thromboembolism, renal and gastrointestinal complications, and infections), and prolonged hospital stay (defined as >28 days). We performed multivariate regression analyses controlling for age and sex.

Results
1919 patients were included in this analysis, mean age 82.6 (SD 8.2); 1357 (70.7%) were women. Multivariate analysis demonstrated that patients with lower mobility levels had a 2.3-5.7-fold higher likelihood of 30-day mortality (p≤0.01), 2.2-2.8-fold higher likelihood of prolonged length of stay (p≤0.004) and 2.1-6.7-fold higher likelihood of living in a care home at 30-days post-surgery (p<0.001). Lower level of mobility was associated with 1.2-1.9-fold higher likelihood of renal complications and 1.2-2.3-fold higher likelihood of infection within 30-days post-surgery (both p<0.001). Lower mobility was associated with 1.3-2.0-fold higher total complication rate within 30-days of surgery (P<0.001).

Conclusion
Mobility prior to fracture is an independent predictor of post-operative mortality, residence, complications and prolonged length of hospital stay.