Atsushi Kimura1, Yoshihiro Matsumoto1, Yoshifumi Wakata2, Akiko Oyamada3, Masanobu Ohishi4, Toshifumi Fujiwara1, Ko Ikuta5, Kuniyoshi Tsuchiya6, Naohisa Tayama7, Shinji Tomari8, Hisaaki Miyahara9, Takao Mae10, Toshihiko Hara11, Taichi Saito12, Takeshi Arizono13, Kozo Kaji14, Taro Mawatari15, Masami Fujiwara16, Riku Sakimura17, Kunichika Shin18, Kenichi Ninomiya19, Kazutoshi Nakaie20, Yasuaki Antoku21, Shoji Tokunaga22, Naoki Nakashima23, Yukihide Iwamoto14, Yasuharu Nakashima1. 1. 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan. 2. 2 Department of Medical Informatics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan. 3. 3 Department of Orthopaedic Surgery, Saga Handicapped Children's Hospital, Saga, Japan. 4. 4 Department of Orthopaedic Surgery, Chihaya Hospital, Fukuoka, Japan. 5. 5 Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, Saga, Japan. 6. 6 Department of Orthopaedic Surgery, JCHO Kyushu Hospital, Fukuoka, Japan. 7. 7 Department of Orthopaedic Surgery, Steel Memorial Yawata Hospital, Fukuoka, Japan. 8. 8 Department of Orthopaedic Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan. 9. 9 Department of Orthopaedic Surgery, National Kyushu Medical Center, Fukuoka, Japan. 10. 10 Department of Orthopaedic Surgery, Saga-ken Medical Center Koseikan, Saga, Japan. 11. 11 Department of Orthopaedic Surgery, Aso Iizuka Hospital, Fukuoka, Japan. 12. 12 Department of Orthopaedic Surgery, Fukuoka City Hospital, Fukuoka, Japan. 13. 13 Department of Orthopaedic Surgery, Kyushu Central Hospital, Fukuoka, Japan. 14. 14 Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan. 15. 15 Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan. 16. 16 Department of Orthopaedic Surgery, Sada Hospital, Fukuoka, Japan. 17. 17 Department of Orthopaedic Surgery, Harasanshin Hospital, Fukuoka, Japan. 18. 18 Department of Orthopaedic Surgery, Saiseikai Yahata General Hospital, Fukuoka, Japan. 19. 19 Department of Orthopaedic Surgery, Koga Hospital 21, Fukuoka, Japan. 20. 20 Department of Orthopaedic Surgery, Fukuoka-Higashi Medical Center, Fukuoka, Japan. 21. 21 Faculty of Medicine, Hospital Informatic Center, Oita University, Oita, Japan. 22. 22 Clinical Research Support Center Kyushu, Fukuoka, Japan. 23. 23 Medical Information Center, Kyushu University Hospital, Fukuoka, Japan.
Abstract
PURPOSE: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. METHODS: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. RESULTS: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8-12.0%, n = 45). Log-rank test revealed that previous fractures (p = 0.003), Barthel index (BI) at discharge (p = 0.011), and place-to-discharge (p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking (p = 0.007), length of hospital stay (LOS; p = 0.009), and BI (p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI <30 (HR 5.42, p = 0.013) were the predictive variables of mortality for male patients. BMI <18.5 kg/m2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS <14 days (HR 13.9; p = 0.007), and BI <30 (HR 2.76; p = 0.049) were the counterparts for females. CONCLUSIONS: Previous vertebral fractures and BI <30 were the predictive variables of mortality for male patients, and BMI <18.5 kg/m2, TCCI ≥5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality.
PURPOSE:Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. METHODS: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. RESULTS: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8-12.0%, n = 45). Log-rank test revealed that previous fractures (p = 0.003), Barthel index (BI) at discharge (p = 0.011), and place-to-discharge (p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking (p = 0.007), length of hospital stay (LOS; p = 0.009), and BI (p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI <30 (HR 5.42, p = 0.013) were the predictive variables of mortality for male patients. BMI <18.5 kg/m2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS <14 days (HR 13.9; p = 0.007), and BI <30 (HR 2.76; p = 0.049) were the counterparts for females. CONCLUSIONS: Previous vertebral fractures and BI <30 were the predictive variables of mortality for male patients, and BMI <18.5 kg/m2, TCCI ≥5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality.
Entities:
Keywords:
Barthel index; activities of daily living; body mass index; frail elderly; hip fractures; mortality rate; osteoporosis