[Replacement of the femoral head due to fracture of the hip: prognostic factors for the duration of hospitalisation, institutionalisation and mortality].
OBJECTIVE
To identify preoperative factors affecting length of hospital stay, residential status and mortality after replacement of the femoral head for a hip fracture.


METHODS
Prospective.


METHODS
Of the 146 consecutive patients who had hemiarthroplasty for a displaced femoral neck fracture in the period 1996-1998, data were recorded on age, sex, the residential situation, ambulation, ADL dependency, the presence of dementia and the classification according to the American Society of Anesthesiologists (ASA). The operations were carried out in the IJsselland Hospital, Capelle aan den IJssel, the Netherlands. The study was terminated in October 2001. With the aid of uni- and multivariate analysis, the relationship was determined between the pre-operative factors and the length of hospital stay, need for institutional care, and mortality within 3 years after the operation.


RESULTS
The study population consisted of 146 patients: 33 men and 113 women with an average age of 82 years (range: 60-98). The length of hospital stay averaged 21 days (range: 2-98). Independent pre-operative predictors for a longer period of hospitalisation were ADL dependency (OR: 1.3; 95% CI: 1.1-15.2), residence at home (0.7; 0.6-0.8), and poor ambulation (1.1; 1.0-1.3). The predictors for permanent institutionalisation were: prior stay in an institution (4-7; 1.1-19.5) and the presence of dementia (3.9; 1.0-1.5). Compared to the general Dutch population of the same age and sex, there was a significant excess mortality during the 3 years after the operation and especially during the first 12 months. Unfavourable prognostic factors for mortality within 3 years after the operation were: poor ambulation before the fracture (3.1; 1.8-5.3), an ASA classification of 3 or 4 (2.0; 1.2-3.1) and an age over 80 years (2.0; 1.2-3.3).


CONCLUSIONS
The risk factors for a longer stay in hospital, placement in an institution or decreased survival in patients who underwent hemiarthroplasty as part of the treatment of a hip fracture can already be identified at the time of admission. The patients with these risk factors should be given special attention during the period of hospitalisation and after-care.
Tjiang
G C
GC
IJsselland Ziekenhuis, afd. Heelkunde, Postbus 690, 2900 AR Capelle aan den IJssel.
Koppert
C L
CL
Hermans
E Th
ET
Poelhekke
L M
LM
Dawson
I
I
D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery*; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006622:Hip Prosthesis; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies