Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review

Abstract

BackgroundHip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures.MethodsWe conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies.ResultsWe retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers.ConclusionsThis systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.

The Association Between Frailty and All-Cause Mortality in Community-Dwelling Older Individuals: An Umbrella Review

“…A total of 969 records were identi ed from the six databases, and after removing the duplicates, 686 were screened for eligibility based on title and abstract. Twenty-three full-text articles were then reviewed for relevance, out of which 18 were excluded because aspects similar to, but not de ned explicitly as, frailty were assessed, e.g., gait speed (17,18), sarcopenia (19), different health indicators (20) or geriatric syndromes (21); outcomes other than mortality were examined, e.g., trauma (22), fractures (23,24), falls (25), high blood pressure and cardiovascular outcomes (26) or heart failure (27); study population included were from clinical practice (28), nursing home (29) or critical care (30) but not from a community setting; the study involved interventions, e.g., treatment modalities (31); or the article was a systematic review protocol or an umbrella review which evaluated frailty scales for clinical outcomes from community, residential care and hospital settings (32)(33)(34). This left ve eligible systematic reviews and meta-analyses in the umbrella review ( Fig.…”

Applying Lean in Process Innovation in Healthcare: The Case of Hip Fracture

“…The number of geriatric hip fractures is expected to rise annually all over the world related to the elderly population ages, which will significantly increase care costs for healthcare systems, patients, relatives, and societies. The incidence of this complication for the elderly in the United States is expected to grow to half a million by 2040, with a worldwide incidence of geriatric hip fractures reaching up to 4.5 million by 2050 [31][32][33]. In Spain, hip fractures are the second highest obstetric and surgical condition in resource consumption after colorectal and anal cancer regarding the average costs of the Diagnosis Related Groups (DRG) [23], with an estimation of 263,351 new hip fractures in women and 84,213 in men between 2010 and 2020, with an existing tendency to increase in older age groups (>80 years) [34].…”

“…Looking for efficiency in the process at hand, with a mortality rate within the first year at 20-33% (that may persist beyond 5 years) is a priority, as is relying on value-based healthcare models [31,32]. In the first three months after surgery, older adults have an eight times higher risks of dying of a hip fracture compared with people who have not suffered from it, continuing the risk of death still in the first ten years [36].…”

“…Furthermore, hip fractures are associated with the development of disability, depression, and cardiovascular diseases in the elderly, with additional cost for society [36]. Therefore, with an increasing incidence and associated poor clinical outcomes, it is relevant to evaluate the impact of hip fractures in the elderly not only on the healthcare system but also in terms of the social impact that is generated by patients as well as by their relatives, the society and the environment [32]. Living in changing times regarding healthcare, political agendas, budgetary limitations, and new leaderships contributes to demanding from professionals the provision of greater value with fewer resources, promoting a bigger impact on patients and other stakeholders [38].…”

Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia

“…For PwD, consequences of falls are even more pronounced. Compared to peers without CI, PwD have a substantially increased risk of serious injuries, such as a twofold higher rate of hip fracture [ 1 , 19 ], as well as decreased functional recovery [ 20 ]. In hospitalized PwD, falls result in a longer length of stay (LOS) in hospitals and up to a 4.5 times higher mortality rate following hospitalization compared to those without dementia [ 19 ], with the mortality risk soaring up tenfold with at least one adverse clinical event, such as a fall, during hospitalization [ 21 ].…”