Tan S.1, Foong J.W.1, Foo C.W.S.1, Ong K.X.K.1
1Changi General Hospital, Rehabilitative Services, Singapore, Singapore
Background: Hip fracture is regarded as the most debilitating fragility fracture as a significant proportion of the elderly patients do not return to their pre-morbid function. Currently, there is no local study investigating predictive factors for functional recovery during the early acute stage.
Purpose: Our study aimed to analyse pre-op and post-operative day one (POD1) factors as predictors of rehabilitation outcomes within the early acute stage (post-operative day four (POD4)) at Changi General Hospital (CGH), Singapore. We hypothesized that identified predictors will enable clinicians to advise patients and families more accurately on their recovery and most importantly, it will facilitate effective discharge planning to ensure efficient allocation of clinical resources for rehabilitation.
Methods: In this longitudinal prospective study, patients who were aged 65-100 years old, admitted between April and September 2016, had undergone single hip fracture surgery and were allowed weight-bearing on POD1 were included. Based on their POD4 ambulation, patients were grouped into good recovery (GR) group able to ambulate ≥20m with minimal assistance or better. The remaining patients formed the poor recovery group. Data pertaining to patients baseline (biometric, social and functional status), injury factor and POD1 indicators were collected. These were analysed based on their groups to assess for possible predictive values and to develop a weighted predictive scoring system.
Results: 126 patients were included in the analysis. 44 patients (34.9%) were in the GR group. In univariate analysis, these five factors had high level of significance premorbid Parker Mobility Score of 7 to 9
(p = 0.001) [adjusted odds ratio (aOR) 2.8; 95% Confidence Interval (CI) 1.05-7.60], absence of dementia (p 0.001) [aOR 3.8; 95% CI 1.09-13.47], ≤2 co-morbidities (p 0.001) [aOR: 3.9; 95% CI 1.45-10.97], ≤1 days pre-operative period (p = 0.003) [aOR: 2.8; 95% CI 0.96-8.23] and able to stand without assistance on POD1 (p 0.001) [aOR 5.6; 95% CI 1.74-18.14]. Risk model analysis was performed with Negative Predictive Value (NPV) (86.4%), specificity (86.4%) and Positive Predictive Value (PPV) (73.2%), sensitivity (73.2%) with a value of 0.837 for the Receiver Operating Characteristic (ROC) Curve. Based on the adjusted odds ratios, a weighted predictive system was developed where patients scoring
8 or more out of 20 were more likely to achieve a good recovery.
Conclusion(s): Regaining ambulatory ability is paramount to recovery from hip fracture. Our weighed predictive scoring system will guide clinicians in prognosticating patients recovery in the early acute stage. Score of 8 out of 20 fulfills clinical criteria for good early recovery and highlights potential patients who are suitable for home discharge.
Implications: Discharge planning should commence as early as possible to minimise length of stay in the acute setting and reduce healthcare costs. This predictive tool serves to highlight patients who will have good recovery as early as at admission and reinforces identification by POD 1. This will facilitate timely and accurate discharge planning and ensure appropriate rehabilitation resource allocation. With early identification of patients who are for home, clinicians can also provide targeted clinical care to optimise preparation for home discharge.
Funding acknowledgements: Nil
Topic: Orthopaedics
Ethics approval: Centralised Institutional Review Board (CIRB), SingHealth, Singapore
All authors, affiliations and abstracts have been published as submitted.
