Factors Affecting Outcome of Proximal Femoral Fracture Surgery Among the Elderly.

Abstract

In spite of following multimodal treatment including medical, surgical intervention and physiotherapy, most elderly with proximal femur fractures do not regain their pre-fracture mobility and activity. This study found factors affecting post-surgical outcome following hip surgery over a 3-year follow-up. Prospective observational cross-over study included 76 patients, ≥ 60 years sustaining proximal femur fracture from November 2017 to April 2019 with an average 3-year follow-up. Decision for surgery was taken after an assessment by the orthopaedician, anaesthesiologist and physician. Patient mobility (Palmer and Parker score), disability (modified Barthel index) and post-operative complications and mortality were studied. On performing multivariate regression, the following was found: (a) age (years) was a significant independent risk factor of poor Parker and Palmer Score {6 months} and poor Barthel index {6 months} after adjusting for confounding factors [OR 1.12 (1.029-1.22) and 1.13 (1.021-1.25)]. (b) Age (years) and pre-operative Parker and Palmer score were significant independent risk factors of poor Parker and Palmer Score {1 year} after adjusting for confounding factors [OR 1.129 (1.017-1.252) and 0.597 (0.379-0.939)]. (c) Increase in pre-operative Barthel index score by 1 unit, duration of hospital stay significantly decreased by 0.148 days and American Society of Anaesthesiologists (ASA) classification (3, 4) had significantly high duration of hospital stay [beta coefficient of 3.642 (1.155-6.13)]. Pre-operative Parker and Palmer score and age are independent risk factors for post-surgical outcome, while ASA classification (3, 4) and pre-operative modified Barthel index score are independent risk factors for duration of hospital stay.