Predictive factors of mortality and deterioration in performance of activities of daily living after hip fracture surgery in Kagoshima, Japan.

Aim: Given that different hospitals achieve different outcomes, optimal evaluation of treatment outcomes in the local community requires evaluation of many institutions in that area. We carried out a prospective multicenter cohort study in Kagoshima Prefecture to identify factors that contribute to deterioration in activities of daily living performance and patient mortality 1 year after surgical treatment of hip fractures. Methods: We prospectively enrolled 387 patients who underwent surgery for hip fractures in 33 registered facilities within a 6-month period from February to July 2007. Logistic regression analysis was carried out to identify factors that contribute to deterioration in activities of daily living performance and death within 1 year after surgery. Results: An increased risk of Barthel Index (BI) deterioration was associated with increased age (P for trend = 0.003), worse pre-injury BI (P for trend = 0.021), trochanteric fractures (OR 2.07, 95% CI 1.31-3.27), worse BI at discharge (P for trend < 0.001) and postoperatively developed cognitive impairment (OR 6.34, 95% CI 2.15-18.7). The OR for BI deterioration in patients with newly-diagnosed disease after discharge was approximately 9.16 (95% CI 4.03-20.8). No factors except age and sex were statistically significant as the preoperative indicators of mortality risk. Only BI at discharge was a significant determinant of mortality risk (P for trend = 0.013) after adjusting for the effects of age and sex. Conclusions: Patients with poor activities of daily living performance at the time of hospital discharge were likely to show poor functional recovery and a high 1-year postoperative mortality.