Background
Methods
Data source and participants
Measures
ASA score
Activities of daily living (ADL)
Recovery of walking ability
Health-related quality of life (HRQoL)
Procedures
Covariates
Results
Participant characteristics
Total Participants | Groups | |||
---|---|---|---|---|
Variable | (n = 226) | ASA 1–2 (n = 114) | ASA 3 (n = 112) |
p-Value |
Age (years) (mean ± SD) | 78.22 ± 7.70 | 77.06 ± 7.40 | 79.39 ± 7.85 | .023a
|
Gender, n (%) | .14 | |||
Male | 78 (34.5%) | 34 (29.8%) | 44 (39.2%) | |
Female | 148 (65.5%) | 80 (70.2%) | 68 (60.7%) | |
Hospital stay (days) (mean ± SD) | 9.96 ± 5.06 | 10.02 ± 4.91 | 9.89 ± 5.24 | .85 |
Education, n (%) | .92 | |||
None | 133 (58.5%) | 69 (60.6%) | 64 (57.1%) | |
Primary | 52 (23.0%) | 24 (21.1%) | 28 (25.0%) | |
High School | 27 (11.9%) | 14 (12.3%) | 13 (11.6%) | |
College or above | 14 (6.2%) | 7 (6.1%) | 7 (6.2%) | |
Fracture classification, n (%) | .73 | |||
Femoral neck | 113 (50.0%) | 57 (50.0%) | 56 (50.0%) | |
Intertrochanteric | 104 (46.0%) | 52 (45.6%) | 52 (46.4%) | |
Subtrochanteric | 9 (4.0%) | 5 (4.4%) | 4 (3.6%) | |
Type of surgery, n (%) | .76 | |||
Arthroplasty | 87 (38.5%) | 45 (39.5%) | 42 (37.5%) | |
Internal fixation | 139 (61.5%) | 69 (60.5%) | 70 (62.5%) | |
Number of comorbidities (mean ± SD) | 0.90 ± 0.85 | 0.77 ± 0.86 | 1.03 ± 0.82 | .024a
|
Presence of comorbidity (type), n (%) | ||||
Cardiovascular disease | 46 (20.4%) | 17 (14.9%) | 29 (25.9%) | .04 |
Hypertension | 99 (43.8%) | 46 (40.4%) | 53 (47.3%) | .29 |
Diabetes mellitus | 58 (25.7%) | 25 (21.0%) | 33 (29.7%) | .20 |
Unable to walk independently pre-fracture, n (%) | 17 (7.5%) | 5 (4.4%) | 12 (10.7%) | .07 |
CBI performance, pre-fracture (mean ± SD) | 97.15 ± 6.39 | 97.72 ± 5.84 | 96.56 ± 6.88 | .174a
|
Differences in service utilization and mortality
Participant Group | |||
---|---|---|---|
Outcome Post-discharge | ASA 1–2 | ASA 3 |
p-Valuea
|
Participants within 1 month, n (% remaining) | 114 (100%) | 112 (100%) | |
Mortality | 0 (0.0%) | 0 (0.0%) | |
Institutionalization | 2 (1.8%) | 7 (6.3%) | .08 |
Emergency room visits | 7 (6.1%) | 9 (8.1%) | .57 |
Hospital readmissions | 6 (5.3%) | 13 (11.6%) | .09 |
Recovery of walking ability | 55 (48.2%) | 33 (29.5%) | .004 |
CBIb score (mean ± SD) | 73.46 ± 19.68 | 68.57 ± 19.43 | .06 |
HRQOLc Subscale Scores (mean ± SD) | |||
Bodily pain | 69.58 ± 24.47 | 71.96 ± 25.09 | .47 |
General health | 62.16 ± 23.41 | 50.02 ± 25.46 | .006 |
Vitality | 57.86 ± 24.55 | 58.38 ± 24.27 | .87 |
Social functioning | 62.61 ± 30.69 | 61.48 ± 29.82 | .78 |
Role disability/emotional | 66.07 ± 44.29 | 66.97 ± 44.09 | .88 |
Mental health | 62.40 ± 22.58 | 63.09 ± 19.78 | .81 |
Physical functioning | 33.93 ± 38.13 | 28.64 ± 38.43 | .30 |
Role disability/physical | 28.57 ± 42.82 | 22.48 ± 37.88 | .26 |
Participants within 3 months, n (% remaining) | 108 (94.7%) | 107 (95.5%) | |
Mortality | 1 (0.9%) | 2 (1.8%) | .55 |
Institutionalization | 3 (2.8%) | 4 (3.7%) | .71 |
Emergency room visits | 5 (4.6%) | 4 (3.7%) | .73 |
Hospital readmissions | 4 (3.7%) | 5 (4.6%) | .73 |
Recovery of walking ability | 79 (73.8%) | 53 (48.6%) | < .001 |
CBIb score (mean ± SD) | 83.19 ± 17.94 | 80.09 ± 17.52 | .20 |
HRQOLc Subscale Scores (mean ± SD) | |||
Bodily pain | 72.10 ± 23.12 | 75.52 ± 24.89 | .31 |
General health | 58.62 ± 24.26 | 52.56 ± 24.14 | .07 |
Vitality | 61.94 ± 21.33 | 62.43 ± 22.17 | .87 |
Social functioning | 59.98 ± 24.60 | 62.14 ± 28.25 | .56 |
Role disability/emotional | 79.17 ± 38.36 | 81.88 ± 35.78 | .60 |
Mental health | 67.25 ± 19.49 | 65.18 ± 21.44 | .47 |
Physical functioning | 31.35 ± 25.35 | 26.36 ± 26.15 | .17 |
Role disability/physical | 20.91 ± 34.33 | 25.73 ± 38.58 | .34 |
Participants within 6 months, n (% remaining) | 102 (89.5%) | 97 (86.6%) | |
Mortality | 2 (1.9%) | 4 (3.7%) | .41 |
Institutionalization | 3 (3.0%) | 3 (3.1%) | .97 |
Emergency room visits | 9 (8.9%) | 10 (10.5%) | .70 |
Hospital readmissions | 7 (6.9%) | 11 (11.6%) | .26 |
Recovery of walking ability | 75 (73.5%) | 64 (64.6%) | 0.17 |
CBIb score (mean ± SD) | 85.49 ± 22.37 | 86.13 ± 17.39 | .82 |
HRQOLc Subscale Scores (mean ± SD) | |||
Bodily pain | 78.10 ± 24.69 | 83.74 ± 22.28 | .10 |
General health | 60.11 ± 23.09 | 57.72 ± 23.87 | .49 |
Vitality | 63.68 ± 21.38 | 65.16 ± 21.90 | .64 |
Social functioning | 73.08 ± 26.54 | 75.41 ± 27.60 | .56 |
Role disability/emotional | 85.51 ± 32.89 | 88.30 ± 30.80 | .55 |
Mental health | 68.04 ± 20.57 | 68.09 ± 18.98 | .95 |
Physical functioning | 55.75 ± 32.47 | 57.23 ± 34.75 | .76 |
Role disability/physical | 33.60 ± 40.96 | 47.85 ± 45.54 | .03 |
Participants within 12 months, n (% remaining) | 84 (73.7%) | 81 (72.3%) | |
Mortality | 3 (3.1%) | 8 (8.1%) | .13 |
Institutionalization | 1 (1.2%) | 3 (3.6%) | .31 |
Emergency room visits | 3 (3.6%) | 8 (10.0%) | .10 |
Hospital readmissions | 5 (6.0%) | 14 (17.3%) | .02 |
Recovery of walking ability | 64 (76.2%) | 56 (67.5%) | .21 |
CBIb score (mean ± SD) | 85.71 ± 26.94 | 87.04 ± 19.55 | .71 |
HRQOLc Subscale Scores (mean ± SD) | |||
Bodily pain | 70.04 ± 26.46 | 77.75 ± 25.83 | .08 |
General health | 53.77 ± 23.67 | 50.60 ± 25.24 | .45 |
Vitality | 60.59 ± 20.25 | 59.93 ± 21.91 | .85 |
Social functioning | 74.30 ± 27.13 | 66.37 ± 30.30 | .10 |
Role disability/emotional | 91.30 ± 25.98 | 82.87 ± 37.11 | .12 |
Mental health | 70.29 ± 19.03 | 63.14 ± 22.70 | .047 |
Physical functioning | 50.70 ± 29.76 | 41.99 ± 31.97 | .09 |
Role disability/physical | 45.07 ± 43.02 | 38.19 ± 45.57 | .36 |
Relationship between ASA score, recovery of physical function, and HRQoL
Time (months post-discharge) | Group | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Outcome variable | 1 | 3a
| 6a
| 12a
| ASA 1-2b
| ASA 3 | ||||
(%)/Mean | β | (%)/Mean | β | (%)/Mean | β | (%)/Mean | (%)/Mean | β | (%)/Mean | |
Walking recovery, %c
| 39% | 0.97 | 63%§
| 1.30 | 70%§†
| 1.4 | 73%§†
| 70% | 0.38 | 53%#
|
CBI score, meand
| 71.91 | 10.27 | 82.18§
| 13.86 | 85.77§†
| 1.39 | 85.85§†
| 81.24 | 13 | 81.62 |
HRQOL scores, meand
| ||||||||||
BP | 71.35 | 2.95 | 74.31 | 10.08 | 81.43§†
| 2.83 | 74.18•
| 72.89 | 4.86 | 77.75#
|
GH | 58.06 | −2.47 | 55.60 | 0.64 | 58.71 | −7.09 | 50.98§†•
| 58.31 | −4.95 | 53.36#
|
VT | 57.8 | 3.56 | 61.37 | 6.05 | 63.85§
| 1.43 | 59.24•
| 59.85 | 1.43 | 61.28 |
SF | 62.76 | −0.93 | 61.50 | 12.06 | 74.49§†
| 7.60 | 70.63§†
| 67.25 | −0.28 | 66.97 |
RE | 66.88 | 13.99 | 80.86§
| 19.94 | 86.81§†
| 18.08 | 85.68§
| 79.65 | 0.82 | 80.47 |
MH | 62.76 | 2.95 | 65.72 | 4.91 | 67.67§
| 2.79 | 65.55 | 65.89 | −0.93 | 64.96 |
PF | 32.72 | −2.45 | 30.27 | 24.22 | 56.94§†
| 11.64 | 44.36§•
| 43.05 | −3.95 | 39.10 |
RP | 27.39 | −2.46 | 24.93 | 13.83 | 41.23§†
| 12.14 | 39.54§†
| 32.81 | 0.93 | 33.74 |