title: Older people with hip fracture and IADL disability require earlier surgery.
abstract: BACKGROUND
  Hip 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Functional 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).
  
  
  CONCLUSIONS
  Surgery 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.
authors.affiliation: Geriatric Unit, Department of Neuromotor Physiology, ASMN Hospital, Via Risorgimento 70, 42100 Reggio Emilia, Italy. giulio.pioli@asmn.re.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Pioli
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lauretani
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Davoli
authors.forename: Emilio
authors.initials: E
authors.lastname: Martini
authors.forename: Carlo
authors.initials: C
authors.lastname: Frondini
authors.forename: Francesca
authors.initials: F
authors.lastname: Pellicciotti
authors.forename: Anna
authors.initials: A
authors.lastname: Zagatti
authors.forename: Antonio
authors.initials: A
authors.lastname: Giordano
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pedriali
authors.forename: Anna
authors.initials: A
authors.lastname: Nardelli
authors.forename: Amedeo
authors.initials: A
authors.lastname: Zurlo
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrari
authors.forename: Maria Lia
authors.initials: ML
authors.lastname: Lunardelli
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods / Q000401:mortality; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome