• J. Gerontol. A Biol. Sci. Med. Sci. · Nov 2012

    Multicenter Study Comparative Study

    Older people with hip fracture and IADL disability require earlier surgery.

    • Giulio Pioli, Fulvio Lauretani, Maria Luisa Davoli, Emilio Martini, Carlo Frondini, Francesca Pellicciotti, Anna Zagatti, Antonio Giordano, Ilaria Pedriali, Anna Nardelli, Amedeo Zurlo, Alberto Ferrari, and Maria Lia Lunardelli.
    • Geriatric Unit, Department of Neuromotor Physiology, ASMN Hospital, Via Risorgimento 70, 42100 Reggio Emilia, Italy. giulio.pioli@asmn.re.it
    • J. Gerontol. A Biol. Sci. Med. Sci. 2012 Nov 1;67(11):1272-7.

    BackgroundHip fractures represent a major challenge for physicians as well as society as a whole. Both poor functional status and delay to surgery are well known risk factors for negative outcomes. We hypothesized that the timing of the operation is more important for frail older people than older people without functional limitations before fracture.MethodsWe performed a prospective multicenter cohort study on 806 consecutive patients, 75 years of age or older, admitted with a fragility hip fracture to three hospitals in the Emilia-Romagna Region (Italy). All three hospitals had a comanaged care model, and the patients were under the shared responsibility of an orthopedic surgeon and a geriatrician.ResultsFunctional status assessed as instrumental activities of daily living was an important predictor of survival after 1 year from fracture. After adjusting for confounders, the hazard ratios per 1 point score of increase from 0 to 8 was 1.30 (95% confidence interval 1.19-1.42, p = .000). Time to surgery increased 1-year mortality in patients with a low instrumental activities of daily living score (hazard ratios per day of surgical delay 1.14, 95% confidence interval 1.06-1.22, p < .001) and intermediate instrumental activities of daily living score (hazard ratios 1.21, 95% confidence interval 1.09-1.34, p < .001) but was an insignificant risk factor in functionally independent patients (hazard ratios 1.05 95% confidence interval 0.79-1.41, p = .706).ConclusionsSurgery delay is an independent factor for mortality in older patients after hip fracture but only for the frail older people with prefracture functional impairment. If our results are confirmed, a more intensive approach should be adopted for older people with hip fractures who have disabilities.

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