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.

Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study / Gandossi, C. M.; Zambon, A.; Ferrara, M. C.; Tassistro, E.; Castoldi, G.; Colombo, F.; Mussi, C.; Martini, E.; Sergi, G.; Coin, A.; Zatti, G.; Trevisan, C.; Volpato, S.; Ungar, A.; Bellelli, G.; Lunardelli, M. L.; Benvenuti, E.; Maggi, S.; Pilotto, A.; Barone, A.; Zurlo, A.; Pizzonia, M.; Antonelli Incalzi, R.; Residori, L.; Cena, P.; Mazzola, P.; Corsi, M.; Greco, A.; Galluccio, R.; Ricco, A.; Molteni, L.; Poli, A.; Bendini, C.; Ceccofiglio, A.; Rubbieri, G.; Mannarino, G.; Cartei, A.; Barghini, E.; Del Lungo, I.; Tognelli, S.; Bandinelli, C.; Venturelli, G.; Cella, A.; Ceolin, C.; Haxhiaj, L.; Laudisio, A.; Residori, L.; Bonetto, M.; Valsecchi, M. G.. - In: AGING CLINICAL AND EXPERIMENTAL RESEARCH. - ISSN 1594-0667. - 35:11(2023), pp. 2499-2506. [10.1007/s40520-023-02522-8]

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

Mussi C.;
2023

Abstract

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.
2023
35
11
2499
2506
Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study / Gandossi, C. M.; Zambon, A.; Ferrara, M. C.; Tassistro, E.; Castoldi, G.; Colombo, F.; Mussi, C.; Martini, E.; Sergi, G.; Coin, A.; Zatti, G.; Trevisan, C.; Volpato, S.; Ungar, A.; Bellelli, G.; Lunardelli, M. L.; Benvenuti, E.; Maggi, S.; Pilotto, A.; Barone, A.; Zurlo, A.; Pizzonia, M.; Antonelli Incalzi, R.; Residori, L.; Cena, P.; Mazzola, P.; Corsi, M.; Greco, A.; Galluccio, R.; Ricco, A.; Molteni, L.; Poli, A.; Bendini, C.; Ceccofiglio, A.; Rubbieri, G.; Mannarino, G.; Cartei, A.; Barghini, E.; Del Lungo, I.; Tognelli, S.; Bandinelli, C.; Venturelli, G.; Cella, A.; Ceolin, C.; Haxhiaj, L.; Laudisio, A.; Residori, L.; Bonetto, M.; Valsecchi, M. G.. - In: AGING CLINICAL AND EXPERIMENTAL RESEARCH. - ISSN 1594-0667. - 35:11(2023), pp. 2499-2506. [10.1007/s40520-023-02522-8]
Gandossi, C. M.; Zambon, A.; Ferrara, M. C.; Tassistro, E.; Castoldi, G.; Colombo, F.; Mussi, C.; Martini, E.; Sergi, G.; Coin, A.; Zatti, G.; Trevisan, C.; Volpato, S.; Ungar, A.; Bellelli, G.; Lunardelli, M. L.; Benvenuti, E.; Maggi, S.; Pilotto, A.; Barone, A.; Zurlo, A.; Pizzonia, M.; Antonelli Incalzi, R.; Residori, L.; Cena, P.; Mazzola, P.; Corsi, M.; Greco, A.; Galluccio, R.; Ricco, A.; Molteni, L.; Poli, A.; Bendini, C.; Ceccofiglio, A.; Rubbieri, G.; Mannarino, G.; Cartei, A.; Barghini, E.; Del Lungo, I.; Tognelli, S.; Bandinelli, C.; Venturelli, G.; Cella, A.; Ceolin, C.; Haxhiaj, L.; Laudisio, A.; Residori, L.; Bonetto, M.; Valsecchi, M. G.
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