Skip to main content
Erschienen in: International Orthopaedics 10/2017

09.08.2017 | Original Paper

The impact of pre-existing conditions on functional outcome and mortality in geriatric hip fracture patients

verfasst von: Christopher Bliemel, Benjamin Buecking, Ludwig Oberkircher, Matthias Knobe, Steffen Ruchholtz, Daphne Eschbach

Erschienen in: International Orthopaedics | Ausgabe 10/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Due to pre-existing illnesses, elderly hip fracture patients represent a vulnerable patient population. The present study was conducted to investigate the effects of various pre-existing conditions on the outcomes of hip fracture patients.

Methods

A total of 402 surgically treated geriatric hip fracture patients were included in this prospective, single-centre study. Upon admission, patient age, gender and fracture type were documented, among other information. Patients were divided into six groups according to their pre-existing illness (neurological, cardiovascular, respiratory, gastrointestinal, renal or musculoskeletal). Outcomes in all six patient groups were measured using the following outcome parameters: length of hospital stay, mobility, functional results and mortality rate at discharge and at the one-year follow-up examination.

Results

Reduced values for the pre-fracture Barthel index (BI) were detected in patients with neurological (p < 0.001) and kidney-related diseases (p = 0.001). Neurological and kidney-related diseases were associated with reduced values on the BI (p < 0.001; p = 0.002) and Tinetti test (TT) (p < 0.001; p = 0.004) as well as an increased mortality rate (p < 0.001; p < 0.001) at the one-year follow-up. In addition, patients with respiratory (p = 0.004) and gastrointestinal disorders (p = 0.007) had an increased mortality rate in the medium term.

Conclusions

Pre-existing conditions are common among geriatric hip fracture patients. Pre-existing neurological and kidney-related diseases had the highest impact on functional outcomes and mortality rates at the end of acute care and in the medium term. In contrast to pre-existing cardiovascular disease, pre-existing neurological, kidney, respiratory and gastrointestinal disorders were also found to be associated with increased mortality rates in the medium term.
Literatur
1.
Zurück zum Zitat Motohashi T, Hamada H, Lee J, Sekimoto M, Imanaka Y (2013) Factors associated with prolonged length of hospital stay of elderly patients in acute care hospitals in Japan: a multilevel analysis of patients with femoral neck fracture. Health Policy 111:60–67. doi:10.1016/j.healthpol.2013.03.014 CrossRefPubMed Motohashi T, Hamada H, Lee J, Sekimoto M, Imanaka Y (2013) Factors associated with prolonged length of hospital stay of elderly patients in acute care hospitals in Japan: a multilevel analysis of patients with femoral neck fracture. Health Policy 111:60–67. doi:10.​1016/​j.​healthpol.​2013.​03.​014 CrossRefPubMed
2.
Zurück zum Zitat Bliemel C, Oberkircher L, Eschbach DA, Struewer J, Ruchholtz S, Buecking B (2013) Surgical treatment of proximal femoral fractures--a training intervention? Z Orthop Unfall 151:180–188. doi:10.1055/s-0032-1328395 CrossRefPubMed Bliemel C, Oberkircher L, Eschbach DA, Struewer J, Ruchholtz S, Buecking B (2013) Surgical treatment of proximal femoral fractures--a training intervention? Z Orthop Unfall 151:180–188. doi:10.​1055/​s-0032-1328395 CrossRefPubMed
3.
Zurück zum Zitat Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209. doi:10.1093/ageing/afp221 CrossRefPubMed Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209. doi:10.​1093/​ageing/​afp221 CrossRefPubMed
4.
Zurück zum Zitat Morice A, Reina N, Gracia G, Bonnevialle P, Laffosse JM, Wytrykowski K, Cavaignac E, Bonnevialle N (2016) Proximal femoral fractures in centenarians. A retrospective analysis of 39 patients. Orthop Traumatol Surg Res. doi:10.1016/j.otsr.2016.09.025 Morice A, Reina N, Gracia G, Bonnevialle P, Laffosse JM, Wytrykowski K, Cavaignac E, Bonnevialle N (2016) Proximal femoral fractures in centenarians. A retrospective analysis of 39 patients. Orthop Traumatol Surg Res. doi:10.​1016/​j.​otsr.​2016.​09.​025
6.
Zurück zum Zitat Middleton M, Wan B, da Assunçāo R (2016) Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing. doi:10.1093/ageing/afw232 Middleton M, Wan B, da Assunçāo R (2016) Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing. doi:10.​1093/​ageing/​afw232
9.
Zurück zum Zitat Bliemel C, Oberkircher L, Eschbach DA, Lechler P, Balzer-Geldsetzer M, Ruchholtz S, Buecking B (2015) Impact of Parkinson’s disease on the acute care treatment and medium-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg. doi:10.1007/s00402-015-2298-3 Bliemel C, Oberkircher L, Eschbach DA, Lechler P, Balzer-Geldsetzer M, Ruchholtz S, Buecking B (2015) Impact of Parkinson’s disease on the acute care treatment and medium-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg. doi:10.​1007/​s00402-015-2298-3
11.
Zurück zum Zitat Bliemel C, Sielski R, Doering B, Dodel R, Balzer-Geldsetzer M, Ruchholtz S, Buecking B (2016) Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture-development of a new scoring system. Osteoporos Int 27:1979–1987. doi:10.1007/s00198-015-3472-8 CrossRefPubMed Bliemel C, Sielski R, Doering B, Dodel R, Balzer-Geldsetzer M, Ruchholtz S, Buecking B (2016) Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture-development of a new scoring system. Osteoporos Int 27:1979–1987. doi:10.​1007/​s00198-015-3472-8 CrossRefPubMed
12.
Zurück zum Zitat Buecking B, Struewer J, Waldermann A, Horstmann K, Schubert N, Balzer-Geldsetzer M, Dodel R, Bohl K, Ruchholtz S, Bliemel C (2014) What determines health-related quality of life in hip fracture patients at the end of acute care?--a prospective observational study. Osteoporos Int 25:475–484. doi:10.1007/s00198-013-2415-5 CrossRefPubMed Buecking B, Struewer J, Waldermann A, Horstmann K, Schubert N, Balzer-Geldsetzer M, Dodel R, Bohl K, Ruchholtz S, Bliemel C (2014) What determines health-related quality of life in hip fracture patients at the end of acute care?--a prospective observational study. Osteoporos Int 25:475–484. doi:10.​1007/​s00198-013-2415-5 CrossRefPubMed
13.
Zurück zum Zitat Eschbach DA, Oberkircher L, Bliemel C, Mohr J, Ruchholtz S, Buecking B (2013) Increased age is not associated with higher incidence of complications, longer stay in acute care hospital and in hospital mortality in geriatric hip fracture patients. Maturitas 74:185–189. doi:10.1016/j.maturitas.2012.11.003 CrossRefPubMed Eschbach DA, Oberkircher L, Bliemel C, Mohr J, Ruchholtz S, Buecking B (2013) Increased age is not associated with higher incidence of complications, longer stay in acute care hospital and in hospital mortality in geriatric hip fracture patients. Maturitas 74:185–189. doi:10.​1016/​j.​maturitas.​2012.​11.​003 CrossRefPubMed
14.
Zurück zum Zitat Gordon M, Berntsson PO, Sjölund E, Demir Y, Hedbeck CJ, Stark A, Sköldenberg O (2016) Loss of offset after pertrochanteric hip fractures affects hip function one year after surgery with a short intramedullary nail. A prospective cohort study. Int Orthop 40:799–806. doi:10.1007/s00264-015-2815-6 CrossRefPubMed Gordon M, Berntsson PO, Sjölund E, Demir Y, Hedbeck CJ, Stark A, Sköldenberg O (2016) Loss of offset after pertrochanteric hip fractures affects hip function one year after surgery with a short intramedullary nail. A prospective cohort study. Int Orthop 40:799–806. doi:10.​1007/​s00264-015-2815-6 CrossRefPubMed
15.
Zurück zum Zitat Sharma G, Singh R, Gn KK, Jain V, Gupta A, Gamanagatti S, Farooque K, Sharma V (2016) Which AO/OTA 31-A2 pertrochanteric fractures can be treated with a dynamic hip screw without developing a lateral wall fracture? A CT-based study. Int Orthop 40:1009–1017. doi:10.1007/s00264-015-2835-2 CrossRefPubMed Sharma G, Singh R, Gn KK, Jain V, Gupta A, Gamanagatti S, Farooque K, Sharma V (2016) Which AO/OTA 31-A2 pertrochanteric fractures can be treated with a dynamic hip screw without developing a lateral wall fracture? A CT-based study. Int Orthop 40:1009–1017. doi:10.​1007/​s00264-015-2835-2 CrossRefPubMed
16.
Zurück zum Zitat Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M (1996) Epidemiology of hip fractures. Bone 18:57S–63SCrossRefPubMed Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M (1996) Epidemiology of hip fractures. Bone 18:57S–63SCrossRefPubMed
19.
Zurück zum Zitat Kisoli A, Gray WK, Dotchin CL, Orega G, Dewhurst F, Paddick SM, Longdon A, Chaote P, Dewhurst M, Walker RW (2015) Levels of functional disability in elderly people in Tanzania with dementia, stroke and Parkinson’s disease. Acta Neuropsychiatr 27:206–212. doi:10.1017/neu.2015.9 CrossRefPubMed Kisoli A, Gray WK, Dotchin CL, Orega G, Dewhurst F, Paddick SM, Longdon A, Chaote P, Dewhurst M, Walker RW (2015) Levels of functional disability in elderly people in Tanzania with dementia, stroke and Parkinson’s disease. Acta Neuropsychiatr 27:206–212. doi:10.​1017/​neu.​2015.​9 CrossRefPubMed
20.
Zurück zum Zitat Fritz NE, Kegelmeyer DA, Kloos AD, Linder S, Park A, Kataki M, Adeli A, Agrawal P, Scharre DW, Kostyk SK (2016) Motor performance differentiates individuals with Lewy body dementia, Parkinson’s and Alzheimer’s disease. Gait Posture 50:1–7. doi:10.1016/j.gaitpost.2016.08.009 CrossRefPubMed Fritz NE, Kegelmeyer DA, Kloos AD, Linder S, Park A, Kataki M, Adeli A, Agrawal P, Scharre DW, Kostyk SK (2016) Motor performance differentiates individuals with Lewy body dementia, Parkinson’s and Alzheimer’s disease. Gait Posture 50:1–7. doi:10.​1016/​j.​gaitpost.​2016.​08.​009 CrossRefPubMed
21.
Zurück zum Zitat Parsons TJ, Sartini C, Ash S, Lennon LT, Wannamethee SG, Lee IM, Whincup PH, Jefferis BJ (2017) Objectively measured physical activity and kidney function in older men; a cross-sectional population-based study. Age Ageing:1–5. doi:10.1093/ageing/afx091 Parsons TJ, Sartini C, Ash S, Lennon LT, Wannamethee SG, Lee IM, Whincup PH, Jefferis BJ (2017) Objectively measured physical activity and kidney function in older men; a cross-sectional population-based study. Age Ageing:1–5. doi:10.​1093/​ageing/​afx091
23.
Zurück zum Zitat Morishita S, Tsubaki A, Shirai N (2017) Physical function was related to mortality in patients with chronic kidney disease and dialysis. Hemodial Int. doi:10.1111/hdi.12564 Morishita S, Tsubaki A, Shirai N (2017) Physical function was related to mortality in patients with chronic kidney disease and dialysis. Hemodial Int. doi:10.​1111/​hdi.​12564
24.
Zurück zum Zitat Penrod JD, Litke A, Hawkes WG, Magaziner J, Doucette JT, Koval KJ, Silberzweig SB, Egol KA, Siu AL (2008) The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 63:867–872CrossRefPubMedPubMedCentral Penrod JD, Litke A, Hawkes WG, Magaziner J, Doucette JT, Koval KJ, Silberzweig SB, Egol KA, Siu AL (2008) The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 63:867–872CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Lacruz ME, Kluttig A, Hartwig S, Löer M, Tiller D, Greiser KH, Werdan K, Haerting J (2015) Prevalence and Incidence of Hypertension in the General Adult Population: Results of the CARLA-Cohort Study. Medicine (Baltimore) 94:e952. doi:10.1097/MD.0000000000000952 CrossRef Lacruz ME, Kluttig A, Hartwig S, Löer M, Tiller D, Greiser KH, Werdan K, Haerting J (2015) Prevalence and Incidence of Hypertension in the General Adult Population: Results of the CARLA-Cohort Study. Medicine (Baltimore) 94:e952. doi:10.​1097/​MD.​0000000000000952​ CrossRef
Metadaten
Titel
The impact of pre-existing conditions on functional outcome and mortality in geriatric hip fracture patients
verfasst von
Christopher Bliemel
Benjamin Buecking
Ludwig Oberkircher
Matthias Knobe
Steffen Ruchholtz
Daphne Eschbach
Publikationsdatum
09.08.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 10/2017
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-017-3591-2

Weitere Artikel der Ausgabe 10/2017

International Orthopaedics 10/2017 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.