Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study
Chiara Gandossi, Antonella Zambon, María Cristina Ferrara, Elena Tassistro, Giuseppe Castoldi, Francesca Colombo, Chiara Mussi, Emilio Martini, Giuseppe Sergi, Alessandra Coin, Giovanni Zatti, Caterina Trevisan, Stefano Volpato, Andrea Ungar, Giuseppe Bellelli, GIOG 2.0 Study Group, Società Italiana di Gerontologia e Geriatria (SIGG), Maria Lia Lunardelli, Enrico Benvenuti, Stefania Maggi, Alberto Pilotto, Antonella Barone, Amedeo Zurlo, Monica Pizzonia, Raffaele Antonelli Incalzi, Luigi Residori, Paola Cena, Paolo Mazzola, Maurizio Corsi, Alessio Greco, Riccardo Galluccio, Alice Riccò, Luca Molteni, Andrea Poli, Chiara Bendini, Alice Ceccofiglio, Gaia Rubbieri, Giulio Mannarino, Alessandro Cartei, Eleonora Barghini, Ilaria Del Lungo, Silvia Tognelli, Chiara Bandinelli, Giulia Venturelli, Alberto Cella, Chiara Ceolin, Labjona Haxhiaj, Alice Laudisio, Luigi Residori, Martina Bonetto, Maria Grazia Valsecchi
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.