The Effect of Pre-Operative Medical Co-Morbidities on Rehabilitation Outcomes Following Surgery for Hip Fracture Management in Geriatric Populations

Abstract

Introduction: As a result of increasing longevity, we are seeing more elderly patients with complex medical co-morbidities who sustain hip fractures requiring surgical management. The aim of this study is to understand and analyze the effect of preoperative medical comorbidities and associated low physiological reserve status on functional rehabilitation outcomes following surgical management of hip fractures. Materials and methods: This study conducted a retrospective analysis of 73 patients who fulfilled the inclusion criteria .We utilized the de Morton Mobility Index (DEMMI) scores pre surgery and at the time of discharge from hospital following a period of rehabilitation as a measure of their pre and post-surgery functional status. The Physiological and Operative Score (POSSUM) was used as our tool to objectively quantify medical co-morbidities including but not limited to cardiovascular and pulmonary conditions. Results: The median age of our study population was 83 years of which 55(75%) were female. Time to surgery was a median of 21.0 hours, IQR (15.0-29.0), with a median physiological score of 21.0, IQR (19.0-26.0), the median pre surgery DEMMI was 85.0, IQR (55.5- 100.0) and the median DEMMI at discharge was 33.0, IQR (30.0-41.0).There is a moderate correlation between DEMMI pre and DEMMI at 3 months, 0.38 that is statistically significant, p = 0.001. Discussion: The effect of medical co- morbidities which causes the patient to have a poor physiological reserve even when coupled with the effect of the operative stress have no significant negative impact on the 90-day functional outcome of these patients. Conclusion: This study demonstrated that the presence of medical comorbidities in patients who require surgical management of hip fractures would not adversely affect their rehabilitation outcomes. The preinjury functional status of a patient is a significant factor in predicting functional rehabilitation outcomes.

C1q and mobility score in predicting sarcopenia in an Australian cohort of cancer surgery patients

“…To the best of our knowledge, this is the first study to explore the relationship between DEMMI scoring and sarcopenia. While previous research has indicated that the DEMMI score is a useful tool for determining patient outcomes, 12–14 we did not see an association with sarcopenia. This may possibly be due to the skewed DEMMI scores (median DEMMI = 100) seen in our study, reflecting a high level of pre‐operative mobility.…”

“…12 It has been increasingly used for predicting functional recovery after surgery. 13,14 Despite a close relationship between mobility scores and sarcopenia, the association between DEMMI score and sarcopenia has not been established. 10 Due to its ease of use, DEMMI may serve an additional function to predict sarcopenia.…”

“…After general surgical procedures, a worse pre‐operative DEMMI score is associated with longer inpatient admission 12 . It has been increasingly used for predicting functional recovery after surgery 13,14 . Despite a close relationship between mobility scores and sarcopenia, the association between DEMMI score and sarcopenia has not been established 10 .…”

The impact of an ageing population on future increases in hip fracture burden

“…7,18 Individuals suffering from a higher number of comorbidities have a poorer functional recovery and prolonged postoperative rehabilitation, with associated financial implications. 23 Such changes will necessitate a considerable increase in resource across health and social care services, with previous estimates anticipating an additional £1.4 billion annually in the UK simply to meet demand. 24 Considering relative comparative hip fracture volumes across England and Scotland, our estimates would suggest a more conservative additional total UK cost of approximately £300 million, although this does not consider increased infrastructure (beds), additional staffing, and theatre resource, as well as recent high inflation.…”

Application of POSSUM and P-POSSUM scores in the risk assessment of elderly hip fracture surgery: systematic review and meta-analysis

“…Generally, the main treatment for hip fractures is surgery, however elderly patients with hip fractures often have many basic diseases when they are admitted to the hospital. George et al [ 3 ] found that when elderly patients with hip fractures had a variety of other diseases, the risk of postoperative morbidity and mortality increased. Their data showed that 20% of the patients had postoperative complications, and the 30-day death rate of such patients was 9%.…”