Health related quality of life, reoperation rate and function in patients with diabetes mellitus and hip fracture—A 2 year follow-up study
Introduction
Old adults with diabetes mellitus sustain an increased risk of hip fracture.1, 2 Up to one-third of seniors above 65 years of age could be affected by diabetes.3 The increased relative risk for a hip fracture in patients with Type 1 and Type 2 diabetes is reported to be within 1.7–12.3, and 1.7, respectively.4 The risk of falling is two- to three fold increased in patients with insulin treated diabetes compared to those without diabetes.5 Other possible problems contributing to the increased fracture risk in diabetes are impaired vision, reduced balance, peripheral neuropathy, hypoglycemic events, impaired bone quality and thiazolidinedione therapy.6, 7, 1 Previous studies evaluating complications and morbidity after a hip fracture have shown that patients with diabetes manage functionally, in aspects of ambulatory ability and Activity Of Daily Living status, as well as patients without diabetes during hospitalisation and later during the postoperative period.8, 9 Other studies indicate that patients with diabetes have an increased mortality risk during the post-operative hospital stay.9, 10 A recent study reported that hip fracture patients with diabetes are at increased risk for post-operative cardiac complications, pressure ulcers and a longer hospital stay, whereas their functional recovery was similar to patients without diabetes after 1 year.11
There are several reports on deteriorated quality of life after hip fracture.12, 13, 14, 15 To our knowledge, evaluation of Health Related Quality of Life (HRQoL) after a hip fracture in the diabetic population has not yet been performed. Thus, the aim of this study was to evaluate the HRQoL, medical and functional outcome in patients with diabetes followed for 2 years after a hip fracture.
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Materials and methods
We included 2133 patients in a prospective study with a 2-year follow-up. Two-hundred and thirty-four (N = 234, 11%) were diagnosed to have diabetes mellitus. Patients with pathological fractures were excluded. The assessment at baseline, data collection and follow-up were performed by research nurses. The study was conducted in conformity with the Helsinki Declaration and was approved by the local Ethics Committee.
The primary assessment included function i.e., walking ability and Activities of
Statistical methods
The statistical software used was SPSS 18.0 for Windows. The Pearson Chi-Square test was used for comparison between groups. Continuous variables were compared with Student t-test. Fischer's exact test was used when sample size was less than 10. The tests were two-sided and the results were considered significant at p < 0.05. Logistic regression analysis was performed with severe pain as the dependent variable and age, gender, ASA classification, surgical method, type of diabetes and fracture, as
Results
Baseline data for all included patients are displayed in Table 1. Among the patients with diabetes 74/234 (32%) had insulin/insulin and oral treatment and 160/234 (68%) of the patients had oral treatment. The mean age was 82 years (SD 8.5) for patients with diabetes and 81 (SD 10.8) for non-diabetic patients. No differences were found in pre-operative living conditions, Activity of Daily Living, Body Mass Index or cognitive function between the groups (Table 1). A lower number of patients with
Surgical outcome
The mean waiting time from fracture to surgery was 1.2 days (SD 0.95, range 0–7days) without any difference between the groups. In patients with diabetes 78% were operated within 0–1 day compared to 76% in the non-diabetes group. There was no difference in distribution of fracture types or surgical method (Table 2, Table 3). At 24 months, 246 patients (11.5%) had a secondary surgery.
Twenty-four patients (10%) among the diabetic population had a re-operation, 7 (10%) patients with
Functional outcome and Health Related Quality of Life
Function and pain for all patients available at each follow-up are displayed in Table 3. At 4 months, 46% of the patients with diabetes reported no pain in the hip vs. 49% in the non-diabetic group (n.s.). Severe pain affected patients with diabetes almost twice as often, i.e. 12% vs. 7% (OR 1.7, p = 0.031) at 4 months. None of the variables tested in the multivariate analyses, i.e. age, gender, type of fracture, type of diabetes, surgical method and ASA were related to the development of severe
Discussion
Patients with diabetes had a marked decline in Health Related Quality of Life after hip fracture but this was not different from patients without diabetes. No increase of medical complications was seen among the diabetic population within the first postoperative year but cardiac and renal failure was more frequent at 24 months in patients with diabetes mellitus. The re-operation rate among patients with diabetes and their functional recovery was similar to that of patients without diabetes even
Conclusion
Patients with diabetes have a marked decline in Health Related Quality of Life after hip fracture but not different from non-diabetic patients. No increase of medical complications was seen among the diabetics within the first postoperative year but cardiac and renal failure became more frequent during the second post-operative year. The re-operation rate among patients with diabetes and their functional recovery was similar to that of the non-diabetes even though more diabetic patients had
Conflict of interest
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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