DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 93
Preoperative factors predicting in-hospital outcome
in patients with hip fracture following multimodal
fast-track rehabilitation concept
Morten Tange Kristensen, Henrik Kehlet
Department of Physiotherapy and Orthopaedic Surgery & Section of
Surgical Pathophysiology,
Copenhagen University Hospital at Rigshospitalet
Background: The concept of multimodal rehabilitation of patients with hip
fracture has proven effective. Still, some patients do not regain their previous
basic mobility independency in the acute orthopaedic setting. Thus, clinicians
need to know the potential of each patient.
Purpose: Previous models established a low prefracture New Mobility Score
(NMS), in addition to older age and having an intertrochanteric fracture as independent
predictors of outcome. Still, such models need to be confirmed. The
aim was to examine the validity of previously established models of in- hospital
outcome after hip fracture surgery.
Methods: A total of 213 consecutive patients (157 women and 56 men) with a
median age of 82 (IQR, 75-88) years, admitted from their own home to a special
hip fracture unit, and following a multimodal optimised rehabilitation concept.
Outcome variables were the regain of independency in basic mobility during
admittance and discharge destination. The Cumulated Ambulation Score
was used to evaluate basic mobility defined as; independency in getting in and
out of bed, sitting down and standing up from a chair, and walking. Discharge
destination was classified as own home or further inpatient rehabilitation facilities
in the community.
Findings: Multiple logistic regression analysis, revealed the prefracture NMS
functional level, age and fracture types as the only independent predictors, when
adjusted for gender, mental and health status. Thus, a patient with a low prefracture
NMS and/or an intertrochanteric fracture was respectively, 6 and 4
times more likely not to regain independency in basic mobility during admittance,
and 4 and 3 times more likely not being discharged to own home, compared
to a patient with a high prefracture NMS level and a cervical fracture,
respectively. Correspondingly, multiple linear regression analyses showed that
patients with a low prefracture NMS level and/or an intertrochanteric fracture,
who actually did regain independent mobility, required on average 2.3 and 2.6
days more to achieve this functional level. Further, odds of not being discharged
directly to own home increased with 9% per each additional year a patient got
older.
Conclusion: The prefracture NMS, age and fracture type were confirmed as
independent predictors of in-hospital outcome in patients with hip fracture who
followed a multimodal rehabilitation concept. Thus, clinicians, using these three
easily available variables, have the possibility to spot patients who may benefit
from special attention and more intensive training.
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