title: Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients.
abstract: BACKGROUND
  The aim of every patient with hip fracture is to regain previous function but we know little about the outcome, especially patient-reported outcome. We wanted to investigate what factors influence the result one year after hip fracture, including fast-track for hip fracture patients, as well as investigating the patients' satisfaction with their rehabilitation and to what degree they regained their pre-fracture function.
  
  
  METHODS
  All patients (>20 years, non-pathological fracture, residents in the catchment area, n=664) having surgery for hip fracture at our hospital during 2011 were included in a retrospective cohort study. From medical records, information was gathered about pre-fracture condition as well as fracture type, surgical details, length of stay and whether the patient entered the hospital through the fast-track system. Medical records were scrutinised for general complications up to six months and for local complications up to one year after surgery. A postal questionnaire was sent one year after surgery inquiring about health status, pain and satisfaction along with multiple-choice questions regarding mobility and rehabilitation. Variables were analysed with linear regression or the proportional odds model.
  
  
  RESULTS
  The most common general complications were new falls, pneumonia and new fractures. Deep infection was the most frequent local complication. The only significant effect of the fast-track system was shorter time to surgery (78 vs. 62% had surgery within 24h, p<0.001). A total of 29% reported to have regained their previous mobility and 30% considered the rehabilitation to be adequate. Mean value for pain VAS was 24 (SD 22) and for satisfaction 28 (SD 25). Absence of general and local complications correlated to satisfaction and hip pain. General complications correlated to loss of function. Higher age correlated to inadequate rehabilitation.
  
  
  CONCLUSIONS
  General complications seem to be the major risk factor, being the only factor affecting functional outcome and together with local complications affecting pain and satisfaction. To avoid general complications, co-operation between orthopaedic surgeons and internists may be crucial in the aftercare of hip fracture patients. A majority did not receive adequate rehabilitation and efforts need to be made to improve the rehabilitation process.
authors: Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden. Electronic address: susanne.hansson@med.lu.se.
authors: Susanne
authors: S
authors: Hansson
authors: Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA.
authors: Ola
authors: O
authors: Rolfson
authors: Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden.
authors: Kristina
authors: K
authors: Åkesson
authors: Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden.
authors: Szilard
authors: S
authors: Nemes
authors: Department of Orthopaedics, Blekinge Hospital, Karlskrona, Sweden.
authors: Olof
authors: O
authors: Leonardsson
authors: Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden; Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden.
authors: Cecilia
authors: C
authors: Rogmark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000534:rehabilitation; D005260:Female; D006305:Health Status Indicators; D006620:Hip Fractures / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Complications; Fast-track; Function; Hip fracture; Patient-reported outcome