title: Pre-fracture hospitalization is associated with worse functional outcome and higher mortality in geriatric hip fracture patients.
abstract: Hip fractures are common in elderly people. Despite great progress in surgical care, the outcomes of these patients remain disappointing. This study determined pre-fracture hospital admission as a prognostic variable for inferior functional outcomes and increased mortality rates in the perioperative phase and in the first postoperative year.
  
  
  OBJECTIVE
  The influence of a pre-fracture hospitalization on outcomes in hip fracture patients has not yet been investigated.
  
  
  METHODS
  Four hundred two patients who were surgically treated for hip fracture were prospectively enrolled. Patients with a hospital stay within the last 3 months prior to a hip fracture were compared to patients without a pre-fracture hospitalization. Postoperative functional outcomes and mortality rates were compared between groups at the time of hospital discharge and additionally at the six- and twelve-month follow-up appointments. A multivariate regression analysis was performed.
  
  
  RESULTS
  A pre-fracture hospitalization was reported by 67 patients (17%). In 63% of cases, patients were admitted due to non-surgical, general medical conditions. In 37% of cases, patients were treated due to a condition related to a surgical subject. In the multivariate analysis, pre-fracture hospitalization was an independent risk factor for reduced values on the Barthel Index at 6 months after surgery (B, -9.918; 95%CI of B, -19.001--0.835; p = 0.032) and on the Tinetti Test at 6 months (B, -2.914; 95%CI of B, -1.992--0.047; p = 0.047) and 12 months after surgery (B, -4.680; 95%CI of B, -8.042--1.319; p = 0.007). Pre-fracture hospitalization was additionally associated with increased mortality rates at 6 months (OR 1.971; 95%CI 1.052-3.693; p = 0.034) and 12 months after surgery (OR 1.888; 95%CI 1.010-9.529; p = 0.046).
  
  
  CONCLUSIONS
  Hip fracture patients with a recent pre-fracture hospital admission are at a substantial risk for inferior functional outcomes and increased mortality rates not only in the perioperative phase but also in the first postoperative year. As a simple dichotomous variable, pre-fracture hospitalization might be a suitable tool for future geriatric hip fracture screening instruments.
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
authors.forename: Rene
authors.initials: R
authors.lastname: Aigner
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Buecking
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
authors.forename: Juliana
authors.initials: J
authors.lastname: Hack
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
authors.forename: Daphne
authors.initials: D
authors.lastname: Eschbach
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Oberkircher
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.affiliation: Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany. bliemel@med.uni-marburg.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bliemel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000401:mortality*; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Geriatric fracture; Hip fracture; Mortality; Outcome; Pre-fracture hospitalization