Risk Factors for Functional Outcomes of the Elderly with Intertrochanteric Fracture: A Retrospective Cohort Study

Objective To identify baseline factors relevant to functional outcomes and health-related quality of life in the elderly with intertrochanteric fractures. Methods For the present study, 168 patients with intertrochanteric fracture who were assigned to different treatments between January 2016 and December 2017 were retrospectively selected. Hip function was assessed by Harris hip score (HHS), and health-related quality of life was evaluated by Barthel index (BI) of activities of daily living (ADL) and EuroQol 5-dimensions (EQ-5D) score, respectively. Data were analyzed by t-test, ANOVA, Pearson's correlation, chi(2)-test, and multivariate linear regression. Results A total of 164 (97.6%) patients completed the follow-up, with an average follow-up time of 15.7 +/- 6.9 months; 39 (23.8%) patients died during the follow-up period and 125 (76.2%) patients were eligible for the functional analysis. HHS at final follow-up of 125 patients was 71.8 +/- 13.1, and the following were associated with hip functional recovery: age (-0.45, 95% confidence interval (CI) -0.73 to -0.18, P < 0.01), serum albumin (0.65, 95% CI 0.04 to 1.27, P < 0.05), and ADL at discharge (0.18, 95% CI 0.01 to 0.33, P < 0.05). The Barthel index at final follow up in this cohort was 80.2 +/- 18.1, and multivariable linear regression analysis showed that age (-0.49, 95% CI -0.85 to -0.12; P < 0.05), ADL score at discharge (0.29, 95% CI 0.07 to 0.51; P < 0.05) and internal fixation (16.3, 95% CI 3.3 to 29.3; P < 0.05) were associated with ADL at final follow-up. EQ-5D at final follow-up was 0.74 +/- 0.2, with which HHS (0.012, 95% CI 0.011 to 0.013; P < 0.01) was positively associated. Conclusion We identify several baseline factors associated with hip functional outcome, health utility, and ADL in the elderly after an intertrochanteric fracture, of which we could modify mutable factors to achieve better outcomes. These findings could help to inform treatment and functional prognosis.