The basic mobility status upon acute hospital discharge is an independent risk factor for mortality up to 5 years after hip fracture surgery: Survival rates of 444 pre-fracture ambulatory patients evaluated with the Cumulated Ambulation Score

• Main Authors: Morten T Kristensen, Henrik Kehlet
• Format: Article
• Language: English
• Published: Taylor & Francis Group 2018-01-01
• Series: Acta Orthopaedica
• Online Access: http://dx.doi.org/10.1080/17453674.2017.1382038

Background and purpose — Mortality rates following hip fracture (HF) surgery are high. We evaluated the influence of the basic mobility status on acute hospital discharge to 1- and 5-year mortality rates after HF. Patients and methods — 444 patients with HF ≥60 years (mean age 81 years, 77% women) being pre-fracture ambulatory and admitted from their own homes, were consecutively included in an in-hospital enhanced recovery program and followed for 5 years. The Cumulated Ambulation Score (CAS, 0–6 points, 6 points equals independence) was used to evaluate the basic mobility status on hospital discharge. Results — 102 patients with a CAS <6 stayed in the acute ward a median of 22 (15–32) days post-surgery as compared with a median of 12 (8–16) days for those 342 patients who achieved a CAS =6. Overall 1-year mortality was 16%; in those with CAS <6 it was 30% and in those with CAS =6 it was 12%. Corresponding data for 5-year deaths were 78% and 50%. Multivariable Cox regression analysis demonstrated that the likelihood of not surviving the first 5 years after hip fracture was 1.5 times higher for those with a CAS <6 and for men; 2 times higher for those 80 years or older; increased by 50% per point higher ASA grade; and was reduced by 11% per point higher New Mobility Score, when adjusted for the cognitive and fracture type status. Interpretation — Further studies focused on interventions that improve the basic mobility status of patients with HF should be instigated within the early time period following surgery.