title: Predictive factors of mortality and deterioration in performance of activities of daily living after hip fracture surgery in Kagoshima, Japan.
abstract: OBJECTIVE
  Given that different hospitals achieve different outcomes, optimal evaluation of treatment outcomes in the local community requires evaluation of many institutions in that area. We carried out a prospective multicenter cohort study in Kagoshima Prefecture to identify factors that contribute to deterioration in activities of daily living performance and patient mortality 1 year after surgical treatment of hip fractures.
  
  
  METHODS
  We prospectively enrolled 387 patients who underwent surgery for hip fractures in 33 registered facilities within a 6-month period from February to July 2007. Logistic regression analysis was carried out to identify factors that contribute to deterioration in activities of daily living performance and death within 1 year after surgery.
  
  
  RESULTS
  An increased risk of Barthel Index (BI) deterioration was associated with increased age (P for trend = 0.003), worse pre-injury BI (P for trend = 0.021), trochanteric fractures (OR 2.07, 95% CI 1.31-3.27), worse BI at discharge (P for trend < 0.001) and postoperatively developed cognitive impairment (OR 6.34, 95% CI 2.15-18.7). The OR for BI deterioration in patients with newly-diagnosed disease after discharge was approximately 9.16 (95% CI 4.03-20.8). No factors except age and sex were statistically significant as the preoperative indicators of mortality risk. Only BI at discharge was a significant determinant of mortality risk (P for trend = 0.013) after adjusting for the effects of age and sex.
  
  
  CONCLUSIONS
  Patients with poor activities of daily living performance at the time of hospital discharge were likely to show poor functional recovery and a high 1-year postoperative mortality. Geriatr Gerontol Int 2017; 17: 391-401.
authors.affiliation: Department of Medical Joint Materials, Kagoshima University, Kagoshima, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishidou
authors.affiliation: Department of Epidemiology and Preventive Medicine, Kagoshima University, Kagoshima, Japan.
authors.forename: Chihaya
authors.initials: C
authors.lastname: Koriyama
authors.affiliation: Department of Orthopedic Surgery, Kagoshima University, Kagoshima, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Kakoi
authors.affiliation: The Near-Future Locomotor Organ Medicine Creation Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Setoguchi
authors.affiliation: Department of Orthopedic Surgery, Kagoshima University, Kagoshima, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagano
authors.affiliation: Department of Orthopedic Surgery, Kagoshima University, Kagoshima, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Hirotsu
authors.affiliation: Department of Orthopedic Surgery, Kagoshima University, Kagoshima, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Orthopedic Surgery, Kagoshima University, Kagoshima, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yokouchi
authors.affiliation: Department of Orthopedic Surgery, Kagoshima University, Kagoshima, Japan.
authors.forename: Setsuro
authors.initials: S
authors.lastname: Komiya
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D002423:Cause of Death; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods; D015577:Geriatric Assessment / Q000379:methods; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D018570:Risk Assessment; D015996:Survival Rate
keywords: activities of daily living; cohort study; hip fracture; mortality