Functionality, comorbidity, complication &amp; surgery of hip fracture in older adults by age distribution

Jiménez-Mola, Sonia; Calvo-Lobo, César; Idoate-Gil, Javier; Seco-Calvo, Jesús

doi:10.1590/1806-9282.64.05.420

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ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 64 (5) • May 2018 • https://doi.org/10.1590/1806-9282.64.05.420 copy

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

BACKGROUND

Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures.

METHODS

A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75–84, 85–90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed.

RESULTS

The age ranges did not show any statistically-significant differences (P<.05; R²=.000–.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R²=.011–.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson’s disease, aortic stenosis, surgery type, ASA–score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R²=.000–.010).

CONCLUSION

Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

Age Distribution; Frail Elderly; Hip Fractures; Musculoskeletal Diseases

Outcomes	Category	Age distribution (y)			χ²	Df	Pt	Effect
	(N=189)	(N=180)	(N=165)					size
	75 - 84	85 - 90	> 90					R²
Functionality
BARTHEL	Total dependence	8.5% (16)	15.6% (28)	12.1% (20)
	Severe dependence	16.4% (31)	22.8% (41)	17.6% (29)
	Moderate dependence	26.5% (50)	26.1% (47)	37.6% (62)	35.06	8	.000**	.062
	Slight dependence	3.7% (7)	6.1% (11)	11.5% (19)
	Independence	45.0% (85)	29.4% (53)	21.1% (35)
Ambulation	Independence/1 stick	68.8% (130)	62.2% (112)	61.8% (102)
	Walker/2 sticks	24.3% (46)	25.6% (46)	28.5% (47)	5.76	6	.451 ^NS	.011
	High assistance	3.7% (7)	7.2% (13)	7.3% (12)	5.76	6	.451 ^NS	.011
	Not walk	3.2% (6)	5.0% (9)	2.4% (4)
Cognitive impairment	No impairment	70.4% (133)	43.9% (79)	49.1% (81)
	Slight	11.6% (22)	25.0% (45)	25.5% (42)	31.28	6	.000**	.055
	Moderate	14.8% (28)	25.0% (45)	21.8% (36)	31.28	6	.000**	.055
	Severe	3.2% (6)	6.1% (11)	3.6% (6)
Comorbidities
Cardiopathy	400	72.5% (137)	77.2% (139)	75.2% (124)	1.11	2	.575 ^NS	.002
Hypertension	377	67.7% (128)	71.1% (128)	73.3% (121)	1.37	2	.504 ^NS	.003
Depression	158	29.1% (55)	31.7% (57)	27.9% (46)	0.63	2	.731 ^NS	.001
Dementia	132	18.0% (34)	31.1% (56)	25.5% (42)	8.60	2	.014 *	.016
Diabetes	127	27.5% (52)	24.4% (44)	18.8% (31)	3.77	2	.152 ^NS	.007
Osteoarthritis	117	24.9% (47)	20.6% (37)	20.0% (33)	1.51	2	.470 ^NS	.003
Atrial fibrillation	107	21.2% (40)	21.1% (38)	17.6% (29)	0.90	2	.637 ^NS	.002
Visual impairment	89	13.8% (26)	18.3% (33)	18.2% (30)	1.79	2	.410 ^NS	.003
Ictus	85	16.4% (31)	15.6% (28)	15.8% (26)	0.05	2	.973 ^NS	.000
Chronic renal failure	83	13.2% (25)	18.3% (33)	15.2% (25)	1.86	2	.395 ^NS	.003
COPD	82	18.0% (34)	16.7% (30)	10.9% (18)	3.76	2	.153 ^NS	.007
Cancer	72	13.2% (25)	11.7% (21)	15.8% (26)	1.25	2	.535 ^NS	.002
Multiple falls	62	13.2% (25)	11.7% (21)	9.7% (16)	1.07	2	.585 ^NS	.002
Anemia	61	10.1% (19)	10.0% (18)	14.5% (24)	2.30	2	.317 ^NS	.004
Osteoporosis	58	14.8% (28)	10.6% (19)	6.7% (11)	6.07	2	.048 *	.011
Peripheral vascular disease	56	11.1% (21)	7.8% (14)	12.7% (21)	2.37	2	.306 ^NS	.004
Ischemic heart disease	46	9.5% (18)	8.9% (16)	7.3% (12)	0.59	2	.743 ^NS	.001
Prior hip fracture	38	6.3% (12)	7.2% (13)	7.9% (13)	0.32	2	.854 ^NS	.001
Parkinson's disease	28	5.8% (11)	7.8% (14)	1.8% (3)	6.35	2	.042 *	.012
Dysphagia	17	2.1% (4)	3.9% (7)	3.6% (6)	1.10	2	.577 ^NS	.002
Aortic stenosis	13	4.8% (9)	1.7% (3)	0.6% (1)	7.08	2	.029 *	.013

Outcomes	Category / n	Age distribution (y)			χ²	Df	p^†	Effect
Outcomes	Category / n							Effect
75 - 84	85 - 90	> 90						size R²
Surgical characteristics
Surgery	Sí	92.6% (175)	96.1% (173)	91.5% (151)	3.32	2	.190 ^NS	.006
Surgical urgency	Sí	12.7% (24)	14.4% (26)	12.1% (20)	0.45	2	.798 ^NS	.001
Surgery type	Nail	49.7% (87)	56.5% (98)	59.6% (90)	88.34	8	.000**	.151
	Partial bipolar prosthesis	28.6% (50)	34.1% (59)	19.9% (30)
	Monopolar prosthesis	1.1% (2)	5.2% (9)	17.9% (27)
	Total prosthesis	16.0% (28)	0.6% (1)	--
	Screws	4.6% (8)	3.5% (6)	2.6% (4)
ASA scores	II - Grade	31.9% (60)	21.7% (39)	18.2% (30)	12.22	4	.016 *	.023
	III - Grade	53.7% (101)	67.2% (121)	68.5% (113)
	IV - Grade	14.4% (27)	11.1% (20)	13.3% (22)
Non-surgical	Death (n=15)	28.6% (4)	42.9% (3)	57.1% (8)	14.53	6	.024 *	.247
cause	Orthopedic care (n=7)	7.1% (1)	42.9% (3)	21.5% (3)
	High surgical risk (n=7)	28.6% (4)	0%	21.4% (3)
	Hospital transfer (n=6)	35.7% (n=5)	14.3% (n=1)	0%
Pharmacologic treatments at baseline
Anti-hypertensives	390	68.3% (129)	75.6% (136)	75.8% (125)	3.40	2	.183 ^NS	.006
Benzodiazepines	189	30.7% (58)	30.0% (54)	46.7% (77)	13.29	2	.001**	.025
Antidepressants	171	32.8% (62)	35.6% (64)	27.3% (45)	2.80	2	.247 ^NS	.005
Proton-pump inhibitors	157	28.0% (53)	30.6% (55)	29.7% (49)	0.29	2	.865 ^NS	.001
Antiplatelets	150	24.3% (46)	33.9% (61)	26.1% (43)	4.65	2	.098 ^NS	.009
Anticoagulants	100	20.1% (38)	21.1% (38)	14.5% (24)	2.80	2	.246 ^NS	.005
Oral antidiabetic agents	96	21.2% (40)	15.6% (28)	17.0% (28)	2.13	2	.345 ^NS	.004
Analgesics	94	22.2% (42)	15.0% (27)	15.2% (25)	4.31	2	.116 ^NS	.008
Antidementia	63	12.7% (24)	15.6% (28)	6.7% (11)	6.77	2	.034 *	.013
Neuroleptics	52	8.5% (16)	11.7% (21)	9.1% (15)	1.19	2	.552 ^NS	.002
Anti-osteoporosis	44	12.2% (23)	6.1% (11)	6.1% (10)	5.60	2	.049 *	.011
Bronchodilators	40	7.9% (15)	7.8% (14)	6.7% (11)	0.24	2	.888 ^NS	.000
Domiciliary Oxygen	28	4.8% (9)	6.7% (12)	4.2% (7)	1.16	2	.561 ^NS	.002
Anti-Parkinsonians	28	6.3% (12)	7.2% (13)	1.8% (3)	5.78	2	.056 ^NS	.010
Insulin	24	7.9% (15)	3.9% (7)	1.2% (2)	9.51	2	.009**	.018

Outcomes	N	Age distribution (y)			χ²	Df	P^†	Effect
	(N=189)	(N=180)	(N=165)					size R²
	75 - 84	85 - 90	> 90					size R²
Complicaciones
Anemia	469	88.4% (167)	85.0% (153)	90.3% (149)	2.34	2	.310 ^NS	.004
Transfusion	208	36.5% (69)	40.0% (72)	40.6% (67)	0.75	2	.688 ^NS	.001
Delirium	196	30.7% (58)	38.9% (70)	41.2% (68)	4.76	2	.093 ^NS	.009
Constipation	117	24.9% (47)	17.2% (31)	23.6% (39)	3.57	2	.168 ^NS	.007
Renal function alteration	94	13.2% (25)	15.6% (28)	24.8% (41)	8.99	2	.011 *	.017
Urinary tract infection	81	12.7% (24)	16.1% (29)	17.0% (28)	1.44	2	.488 ^NS	.003
Infection / Respiratory insufficiency	79	13.2% (25)	13.3% (24)	18.2% (30)	2.18	2	.337 ^NS	.004
Malnutrition	74	14.8% (28)	12.2% (22)	14.5% (24)	0.61	2	.736 ^NS	.001
Heart failure	64	9.5% (18)	9.4% (17)	17.6% (29)	7.08	2	.029 *	.013
Acute retention of urine	50	8.5% (16)	10.0% (18)	9.7% (16)	0.29	2	.866 ^NS	.001
Ischemic heart disease	39	9.5% (18)	7.8% (14)	4.2% (7)	3.72	2	.156 ^NS	.007
Death	31	4.8% (9)	3.9% (7)	9.1% (15)	4.84	2	.089 ^NS	.009
Pressure ulcers	21	5.3% (10)	2.2% (4)	4.2% (7)	2.36	2	.307 ^NS	.004
Seroma	9	2.6% (5)	0.6% (1)	1.8% (3)	--	--	--	--
Surgical wound infection	4	1.1% (2)	0.6% (1)	0.6% (1)	--	--	--	--
Ictus	3	1.1% (2)	0%	0.6% (1)	--	--	--	--
Venous thrombosis/Thromboem-bolism	2	0%	0%	1.2% (2)	--	--	--	--
Features at hospital discharge
Destination	Concerted care center	31.6% (55)	27.6% (47)	37.3% (56)
	Nursing home	25.3% (44)	33.5% (57)	35.3% (53)	19.22	6	.004**	.038
	Family home	17.2% (30)	22.9% (39)	17.3% (26)
	Own home	25.9% (45)	15.9% (27)	10.0% (15)
Home move	Yes	10.3% (18)	11.1% (19)	8.0% (12)
	No	58.6% (102)	62.0% (106)	54.7% (82)	4.35	4	.361 ^NS	.009
	Hospital concerted center	31.0% (54)	26.9% (46)	37.3% (56)	4.35	4	.361 ^NS	.009
Ambulation	Independence/1 stick	1.7% (3)	0%	0%
	Walker/2 sticks	41.1% (72)	32.0% (55)	22.7% (34)	19.14	6	.004**	.037
	High assistance	22.9% (40)	25.6% (44)	29.3% (44)
	Not walk	34.3% (60)	42.4% (73)	48.0% (72)
Discharge	Yes	14.9% (26)	9.3% (16)	16.0% (24)	3.71	2	.157 ^NS	.007

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[1] CORRESPONDING AUTHOR: César Calvo-Lobo. Av. Astorga, s/n – Ponferrada – León, Spain – 24401 – Tel: 605811782 – Fax: 605. E-mail: cecalvo19@hotmail.com, fjavieridoate@gmail.com, dr.seco.jesus@gmail.com, soniajimenezmola@hotmail.com