Association between Cognitive Status before Surgery and Outcomes in Elderly Patients with Hip Fracture in a Dedicated Orthogeriatric Care Pathway

Article type: Research Article

Authors: Zerah, Lorene^{a; b} | Cohen-Bittan, Judith^a | Raux, Mathieu^{b; c} | Meziere, Anthony^d | Tourette, Cendrine^{b; e} | Neri, Christian^{b; e} | Verny, Marc^{a; b; e} | Riou, Bruno^{b; f} | Khiami, Frederic^g | Boddaert, Jacques^{a; b; e; *}

Affiliations: [a] Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France | [b] Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France | [c] Departments of Anesthesiology and Critical Care, GH Pitié-Salpêtrière, APHP, Paris, France | [d] Department of Rehabilitation, GH Charles Foix, APHP, Ivry sur Seine, France | [e] Centre National de la Recherche Scientifique (CNRS), UMR 8256, Paris, France | [f] Departments of Emergency Medicine and Surgery, GH Pitié-Salpêtrière, APHP, Paris, France | [g] Departments of Orthopedic Surgery and Trauma, GH Pitié-Salpêtrière, APHP, Paris, France

Correspondence: [*] Correspondence to: Pr. Jacques Boddaert, Unit of Peri-Operative Geriatric care, GH Pitié-Salpêtrière, 47-83 Boulevard de l’Hôpital, 75013 Paris, France. Tel.: +33 1 42164117; Fax: +33 1 42160626; E-mail: [email protected].

Abstract: Background: Dementia is associated with a worse prognosis of hip fracture, but the impact of a dedicated geriatric care pathway on the prognosis of these patients has not been evaluated. Objective: According to the cognitive status before surgery, our main objective was to compare mortality rate at 6 months; secondary outcomes were to compare in-hospital complications, the risk of new institutionalization, and the ability to walk at 6 months. Methods: Between 2009 and 2015, all patients (>70 years) admitted after hip fracture surgery into a dedicated unit of peri-operative geriatric care were included: patients with dementia (DP), without dementia (NDP), and with cognitive status not determined (CSND). Data are expressed as hazard ratio (HR) for multivariate cox analysis or odds ratio (OR) for multivariate logistic regression analysis and their 95% confidence interval (CI). Results: We included 650 patients (86±6 years): 168 DP, 400 NDP, and 82 CSND. After adjustment for age, sex, comorbidities, polypharmacy, pre-fracture autonomy, time-to-surgery, and delirium, there were no significant differences for 6-month mortality (DP versus NDP: HR = 0.7[0.4–1.2], DP versus CSND: HR = 0.6[0.3–1.4], CSND versus NDP: HR = 0.8[0.4–1.7]); but DP and CSND were more likely to be newly institutionalized after 6 months compared to NDP (OR DP = 2.6[1.4–4.9], p = 0.003, OR CSND = 2.9[1.4–6.1], p = 0.004). 92% of population was walking after 6 months (63% with assistance): no difference was found between the three groups. Conclusion: In a dedicated geriatric care pathway, DP and CSND undergoing hip surgery have the same 6-month mortality and walking ability as NDP.

Keywords: Dementia, elderly, hip fracture, unit of peri-operative geriatric care

DOI: 10.3233/JAD-160655

Journal: Journal of Alzheimer's Disease, vol. 56, no. 1, pp. 145-156, 2017