title: Impact of Parkinson's disease on the acute care treatment and medium-term functional outcome in geriatric hip fracture patients.
abstract: BACKGROUND
  Patients with Parkinson's disease (PD) have a heightened risk of sustaining hip fractures due to disturbed balance and gait insecurity. This study aims to determine the impact of PD on the perioperative course and medium-term functional outcome of patients with hip fractures.
  
  
  METHODS
  A total of 402 hip fracture patients, aged ≥60 years, were prospectively enrolled. On admission, the American Society of Anesthesiologists score, Mini-Mental Status Examination, and Barthel Index (BI), among other scales, were documented. The Hoehn and Yahr scale was used to assess the severity of PD. The functional outcome was assessed by performance on the BI, Tinetti test (TT), and Timed Up and Go test (TUG) at discharge and at the 6-month follow-up. Additionally, the length of hospitalization, perioperative complications, and discharge management were documented. A multivariate regression analysis was performed to control for influencing factors.
  
  
  RESULTS
  A total of 19 patients (4.7%) had a concomitant diagnosis of PD. The functional outcome (BI, TT, and TUG) was comparable between groups (all p > 0.05). Grade II (52.6 vs. 26.1%; OR = 4.304, p = 0.008) and IV complications (15.8 vs. 4.4%; OR = 7.785, p = 0.012) occurred significantly more often among PD patients. While the diagnosis of PD was associated with a significantly longer mean length of hospital stay (β = 0.119, p = 0.024), the transfer from acute hospital care showed no significant difference (p = 0.246). Patients with an additional diagnosis of PD had inferior results in BI at the 6-month follow-up (p = 0.038).
  
  
  CONCLUSIONS
  PD on hospital admission is not an independent risk factor for in-hospital mortality or an inferior functional outcome at hospital discharge. However, patients with PD are at risk for specific complications and longer hospitalization at the time of transfer from acute care so as for reduced abilities in activities of daily living in the medium term.
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany. bliemel@med.uni-marburg.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bliemel
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany. oberkirc@med.uni-marburg.de.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Oberkircher
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany. eschbach@med.uni-marburg.de.
authors.forename: Daphne-Asimenia
authors.initials: DA
authors.lastname: Eschbach
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany. lechler@med.uni-marburg.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lechler
authors.affiliation: Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany. balzerge@staff.uni-marburg.de.
authors.forename: Monika
authors.initials: M
authors.lastname: Balzer-Geldsetzer
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany. ruchholt@med.uni-marburg.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany. buecking@med.uni-marburg.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Buecking
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Complication; Geriatric fracture; Hip fracture; Outcome; Parkinson’s disease