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

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.