Authors (including presenting author) :
AU ILY(1), CHAN ACM(1), CHAN DWL(1), LEE KB(2), TIU KL(2), LAU JCK(2)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital, (2)Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital
Introduction :
Hip fracture is common in elderly after fall, resulting in subsequent disability, lower quality of life, mortality and increase in healthcare burden. Annually, over 8,000 patients were admitted to Hospital Authority in Hong Kong due to traumatic hip fracture while Queen Elizabeth Hospital (QEH) accounted for 13.7%. Hip fracture is mostly treated operatively, followed by rehabilitation to enhance functional recovery and decrease risks of complications. Rehabilitation plan and prognosis can be determined by early functional outcome. In the meanwhile, 1-year mortality rate of hip fracture patients is high, approximately 18% in Hong Kong. Numerous factors are shown to be significant prognostic predictors; however, limited studies have investigated the contribution from Sarcopenia on functional outcome and 1-year mortality.
Objectives :
To investigate the relationship among Sarcopenia, early functional outcome and 1-Year Mortality in Hong Kong Chinese geriatric ambulatory patients with hip fracture.
Methodology :
A retrospective longitudinal study was conducted. Patients aged 65 years old or above and admitted to the QEH due to acute hip fracture after fall with DXA received within 1 month from April 2016 to March 2017 were reviewed. Patients that were bedbound, with terminal illness or end stage organ failure were excluded. Outcome measures on 1) Relative Appendicular Skeletal Muscle Mass Index (RASM) measured by DXA, 2) Handgrip strength (HGS), 3) Elderly Mobility Scale (EMS) at first ambulation (EMS-1), 4) EMS at discharge from QEH (EMS-DC) and 5) 1-Year Mortality were retrieved for analysis. Definition of Sarcopenia developed by the Asian Working Group for Sarcopenia, analyzing RASM and HGS, was adopted. Correlation between Sarcopenia and EMS was evaluated by rank-biserial correlation analysis. Correlation between Sarcopenia and 1-Year-Mortality was evaluated by Pearson’s Chi-square test. Prediction model of 1-Year Mortality was evaluated using logistic regression analysis.
Result & Outcome :
219 patients (mean age = 83.0 ± 7.2 years) (82 males, 137 females) were reviewed for data analysis. Prevalence of Sarcopenia was 51.6 %. 1-Year Mortality rate was 12.8%. There were significant correlations between Sarcopenia and EMS-1 (rrb = -0.160, p = 0.023), and between Sarcopenia and EMS-DC (rrb = -0.269, p<0.001). Sarcopenia was also associated with 1-Year Mortality (χ2 = 5.290, p = 0.021). 1-Year Mortality rate of patients with Sarcopenia and without Sarcopenia was 18.0% and 7.5% respectively. Sarcopenia was a significant predictor of 1-Year-Mortality. Patients with Sarcopenia were more likely to face mortality within 1 year (R2 = 0.046, OR = 2.692, p = 0.025). Therefore, early detection of Sarcopenia by the collaboration of orthopaedic surgeons and physiotherapists is crucial for early implementation of appropriate rehabilitation and treatment in Hong Kong Chinese geriatric ambulatory patients with hip fracture.
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