The long-term postoperative trajectory of geriatric patients admitted for a hip fracture: A prospective observational cohort study

Background: Worldwide, 1.3 million patients sustain a hip fracture every year. In Canada, 23 621 patients over 60 have been admitted with a hip fracture in 2003. Few authors have yet investigated the full postoperative trajectory of patients admitted for a hip fracture, in terms of orientation. Hypothesis: Most geriatric patients undergoing surgery for a hip fracture will not be able to return to their original residence at one-year of follow-up. Objective: To characterize the full one-year postoperative trajectory of patients admitted for a hip fracture, in terms of orientation. Patients and methods: This is a prospective observational cohort study of geriatric patients undergoing surgery for a hip fracture from 2011 to 2017 in an academic center. A total of 254 patients were enrolled in this cohort. Demographic data and scores were collected throughout the hospitalisation. Patients' residences were assessed pre-fracture and at 1, 3, 6 and 12-month post-hospitalisation. Results: Most patients evolved in one of the following trajectories at one-year; (1) 30% (n= 63) went back at home, (2) 11% (n= 22) went back to a senior residence, (3) 16% (n= 36) needed rehabillitation, (4) 13% (n= 28) were discharged to a different location than prior to admission and (5) 18% (n=37) were deceased. Patients evolving in trajectory 1 were younger (mean, 80.8 +/- 11.1, p < 0.0001). Patients evolving in trajectory 5 had lower MNA(1) scores (mean, 19.9 +/- 5.2, p.<0.0001) and lower MMSE2 scores (mean, 16.0 +/- 10.9, p < 0.0001). The delay between discharge from the attending staff and real departure from the hospital was correlated to low MNA scores (-0.35627,p < 0.0001), low MMSE scores (-0.35910, p = 0.0004) and associated with the need for a rehabilitation center (trajectory 3) (mean, 2.67 +/- 4.36 days, p = 0.0002). Discussion: The postoperative evolution of geriatric patients with a hip fracture will continue to worsen due to the aging of the population. However, this study highlights important issues such as nutritional assessment, cognitive disorders and access to rehabilitation centers. (C) 2019 Elsevier Masson SAS. All rights reserved.