Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Gødstrupvej 43, 7400, Herning, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Arch Orthop Trauma Surg. 2023 May;143(5):2475-2484. doi: 10.1007/s00402-022-04472-8. Epub 2022 May 20.
Hip fracture patients are fragile, and the majority fail to fully recover to their pre-fracture functional level, resulting in an increase in institutionalization. We aimed to investigate risk factors for being dependent at discharge and for failure to return to independent living 12 months after a hip fracture.
From 2011 to 2017, all surgically treated hip fracture patients admitted from their own homes were included in this prospective cohort study. Patient characteristics were registered, including age, sex, lifestyle, comorbidities, pre-fracture New Mobility Score (NMS), biochemical measures, fracture type, and surgical method. Dependency was measured at discharge using a cumulated ambulatory score (CAS < 6) and the timed-up-and-go test (TUG > 20 s). At 12 months, patients were interviewed regarding residence, NMS, and care needs. Multivariable logistic regression was used, reporting odds ratio (OR) with 95% confidence intervals (CI).
A total of 2006 patients were included in the study with data regarding their hospital stay and discharge. In all, 1342 patients underwent follow-up at 12 months. The risk factors found to be associated with dependency at discharge were mostly static. Modifiable variables associated with dependency at discharge (CAS < 6) were hypoalbuminemia (OR: 1.94, 95% CI 1.38-2.71), not having been mobilized to standing within 24 h (OR: 1.88, 95% CI 1.12-3.15), and general anesthesia (OR: 1.35, 95% CI 1.07-1.71). Failure to return to independent living at 12 months was found in 10% of the patients, and was primarily associated with patient characteristics and proxy variables for comorbidities, but also with dependency at discharge (CAS < 6).
Mobilizing patients to standing within 24 h from hip fracture surgery was vital in maximizing short-term functional recovery. Failure to return to independent living was seen in the frailest patients. However, the majority remained in their own home with little increase in care needs.
髋部骨折患者身体脆弱，大多数患者无法完全恢复到骨折前的功能水平，从而增加了住院的可能性。我们旨在研究髋部骨折后出院时依赖和无法恢复独立生活 12 个月的风险因素。
从 2011 年到 2017 年，所有从家中接受手术治疗的髋部骨折患者都被纳入了这项前瞻性队列研究。记录了患者的特征，包括年龄、性别、生活方式、合并症、骨折前新移动评分（NMS）、生化指标、骨折类型和手术方法。使用累积步行评分（CAS<6）和计时起立行走测试（TUG>20 秒）在出院时测量依赖性。在 12 个月时，通过询问患者的居住情况、NMS 和护理需求来进行评估。使用多变量逻辑回归，报告比值比（OR）及其 95%置信区间（CI）。
共纳入 2006 例患者，其中包括其住院和出院数据。共有 1342 例患者在 12 个月时进行了随访。与出院时依赖性相关的风险因素大多是静态的。与出院时依赖性相关的可改变的变量（CAS<6）是低白蛋白血症（OR：1.94，95%CI 1.38-2.71）、24 小时内未从床上转移至站立位（OR：1.88，95%CI 1.12-3.15）和全身麻醉（OR：1.35，95%CI 1.07-1.71）。10%的患者在 12 个月时无法恢复独立生活，主要与患者特征和合并症的代理变量相关，但也与出院时的依赖性（CAS<6）相关。
髋部骨折手术后 24 小时内将患者从床上转移至站立位对于最大限度地提高短期功能恢复至关重要。无法恢复独立生活的患者通常是最脆弱的患者。然而，大多数患者仍然住在自己家中，护理需求增加很少。
