Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study

• Published in: Aging clinical and experimental research Vol. 35; no. 11; pp. 2499 - 2506
• Main Authors: Gandossi, Chiara Maria, Zambon, Antonella, Ferrara, Maria Cristina, Tassistro, Elena, Castoldi, Giuseppe, Colombo, Francesca, Mussi, Chiara, Martini, Emilio, Sergi, Giuseppe, Coin, Alessandra, Zatti, Giovanni, Trevisan, Caterina, Volpato, Stefano, Ungar, Andrea, Bellelli, Giuseppe
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-11-2023; Springer Nature B.V
• Subjects: Delirium; Fractures; Frailty; Geriatrics/Gerontology; Hip joint; Medicine; Medicine & Public Health; Original; Original Article; Delirium; Frailty; Hip fracture; Orthogeriatric; Functional outcome
• ISSN: 1720-8319; 1594-0667; 1720-8319
• DOI: 10.1007/s40520-023-02522-8

Background
This study analyzes the effect of frailty and Post-Operative Delirium (POD) on the functional status at hospital discharge and at 4-month follow-up in patients with hip fracture (HF).
Methods
Multicenter prospective observational study of older patients with HF admitted to 12 Italian Orthogeriatric centers (July 2019-August 2022). POD was assessed using the 4AT. A 26-item Frailty Index (FI) was created using data collected on admission. The outcome measures were Cumulated Ambulation Score (CAS) ≤ 2 at discharge and a telephone-administered CAS ≤ 2 after 4 months. Poisson regression models were used to assess the effect of frailty and POD on outcomes.
Results
984 patients (median age 84 years, IQR = 79–89) were recruited: 480 (48.7%) were frail at admission, 311 (31.6%) developed POD, and 158 (15.6%) had both frailty and POD. In a robust Poisson regression, frailty alone (Relative Risk, RR = 1.56, 95% Confidence Intervals, CI 1.19–2.04, p = 0.001) and its combination with POD (RR = 2.57, 95% CI 2.02–3.26, p < 0.001) were associated with poor functional status at discharge. At 4-month follow-up, the combination of frailty with POD (RR 3.65, 95% CI 1.85–7.2, p < 0.001) increased the risk of poor outcome more than frailty alone (RR 2.38, 95% CI 1.21–4.66, p < 0.001).
Conclusions
POD development exacerbates the negative effect that frailty exerts on functional outcomes in HF patients.