Prognostic factors of functional outcome after hip fracture surgery: a systematic review

Sobolev, Boris; Williamson, Lesley E.; Alexander, James B.; Filliter, Christopher; Guy, Pierre; Bearne, Lindsay; Sackley, Catherine

doi:10.1093/ageing/afy057

Cited by 101 publications

(89 citation statements)

References 28 publications

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“…Patients with cognitive impairment have been reported to have a higher risk of poorer functional outcome after hip fracture incidents (Sheehan et al 2018). Hip fracture patients with cognitive impairment are older and have comorbidities that increase the risk of any reoperation.…”

Section: Discussionmentioning

confidence: 99%

Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register

et al. 2020

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“…This screening could assist programs to tailor how the rehabilitation is delivered, in terms of functional contexts, specific cuing, and the incorporation of cognitive training strategies to maximize functional outcomes and potentially reduce length of stay. Cognition is highly impacted by age and can influence the patient's ability to actively participate in the rehabilitation process including goal setting, poor recall and learning, and difficulties with making decision about discharge location and services required [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…The assessment is easy to administer with 18 questions broken down into the areas of visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall, and orientation. The total score is out of 30, with scores being broken down into the following severity levels: intact (26-30), mild cognitive impairment (18)(19)(20)(21)(22)(23)(24)(25), moderate cognitive impairment (10)(11)(12)(13)(14)(15)(16)(17), and severe impairment (9 or less). The occupational therapist completing the assessments was trained to use the MoCA.…”

mentioning

confidence: 99%

Cognitive Status and Outcomes of Older People in Orthopedic Rehabilitation? A Retrospective-Cohort Study

2020

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Background: Cognitive function of older people is not routinely assessed in orthopedic rehabilitation, after elective and non-elective surgery. The aim of this study was to assess cognitive impairment and its impact on both length of stay and functional outcomes, of older people admitted to orthopedic rehabilitation. Methods: Retrospective audit, inclusion criteria: aged >65 years, orthopedic diagnosis, discharged from hospital. Results: 116 files were audited, mean age of 82.3 (SD = 7.5) years. Diagnostic groups: fractured neck of femur, (n = 44, 37.98%); elective surgery (n = 42, 36.21%); and other orthopedic conditions (n = 30, 25.86%). Overall 71.55% (n = 83) had cognitive impairment, with a median of mild cognitive impairment across all diagnoses. Both measures of cognition (MoCA/FIM Cognitive) were significantly associated with length of stay (p < 0.01), function (p < 0.05), and discharge destination (p = 0.01). Conclusions: A high percentage of older orthopedic patients in rehabilitation with both elective and non-elective diagnoses have cognitive impairment. Cognitive screening is recommended for all older orthopedic patients in rehabilitation, to inform an individualized rehabilitation plan to improve outcomes and length of stay. Further research is required to explore cognitive strategies to maximize rehabilitation outcomes in the geriatric orthopedic population.

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“…Recovery and discharge from hospital following hip fracture is understood by patients, carers or staff as a complex interplay between medical conditions, psychosocial factors and the practicalities of living with increased dependency [29,30]. A model of improving outcomes focussed solely on a medical complications model is unlikely to be fully effective.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing postoperative LOS after fragility hip fracture surgery: public perceptions – a mixed methods study

Marufu

Almghairbi

Elphick

et al. 2019

Preprint

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Background Postoperative patient outcomes after hip fracture are significant to patients and their relatives, clinicians and policy makers. However, little is known about the collective views of these stakeholders on postoperative factors perceived to cause prolonged hospitalisation in this patient population. We aimed to explore individual stakeholders’ opinions on factors influencing timing of discharge.Methods Using a mixed methods approach, healthcare professionals, patients and relatives completed a questionnaire and interviews. The questionnaire consisted of 13 morbidity and non-medical domains on a five-point Likert scale. Participants were asked to rank each item identifying its importance in influencing length of hospital stay; 1 = strongly disagree, 2 = disagree, 3 = neither disagree nor agree, 4 = agree, 5 = strongly agree. Interviews were semi-structured exploring participant perceptions.Findings Twenty-six participants completed both interviews and questionnaires; three completed questionnaires only. Five themes affecting LOS emerged from interview data analysis; medical conditions, age and frailty, psychological aspects, the recovery process and social issues. There were some differences between the importance attributed by the semi-quantitative rating scales and the qualitative themes generated. Quantitative data suggested medical factors (pulmonary, infectious, gastrointestinal, cardiovascular, neurological, haematological, wound and pain). The interviews however highlighted functional and social aspects of recovery as key for patients and relative participants.Conclusion Recovery and discharge from hospital following hip fracture is understood by patients, carers or staff to be a complex interplay between medical conditions, psychosocial factors and the practicalities of living with increased dependency. Approaches to improving outcome will need to address each of these domains if they are to be effective.

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Prognostic factors of functional outcome after hip fracture surgery: a systematic review

Abstract: we identified one modifiable and one immutable prognostic factor for functional outcomes after hip fracture surgery. Future research may target patients with anaemia or cognitive impairment by intervening on the prognostic factor or the underlying mechanisms.

Cited by 101 publications

References 28 publications

Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register

Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register

Cognitive Status and Outcomes of Older People in Orthopedic Rehabilitation? A Retrospective-Cohort Study

Factors influencing postoperative LOS after fragility hip fracture surgery: public perceptions – a mixed methods study

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