Association between fall location and postoperative clinical outcomes after fragility hip fracture: a multicentre cohort study.
Indoor falls in older adults with hip fractures are associated with higher risks of functional dependence and mortality, highlighting the need for careful risk assessment in this population.
Where it sits
this study against the rest of the ara 290 corpusSummary and findings
This study investigated the association between fall location and postoperative outcomes in patients aged ≥50 years with fragility hip fractures. Among 5,391 patients, 3,480 (64.6%) sustained indoor falls and 1,911 (35.4%) sustained outdoor falls. Indoor falls were associated with higher risks of functional dependence, gait impairment, and mortality.
Abstract
<h4>Background</h4>Fall location may serve as a marker of underlying vulnerability in adults with fragility hip fractures; however, its association with postoperative outcomes remains unclear. This study investigated this association using multicentre prospective registry data.<h4>Materials and methods</h4>This retrospective multicentre cohort study analysed Korean Hip Fracture Registry data, including patients aged ≥50 years with proximal femoral fractures treated between June 2016 and December 2024. Fall location was classified as indoor or outdoor. Primary outcomes were functional dependence, gait impairment, and mortality, whereas secondary outcomes included postoperative complications and discharge destination. Logistic regression analysed functional dependence, gait impairment, complications, and discharge destination, whereas Cox proportional hazard regression analysed mortality. Adjusted odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated; sequential adjustment analyses assessed potential confounding.<h4>Results</h4>Among 5,391 patients with fragility hip fractures, 3,480 (64.6%) sustained indoor falls and 1,911 (35.4%) sustained outdoor falls. Mean follow-up was approximately six months, and most indoor falls occurred at home (80.8%). Compared with outdoor fallers, indoor fallers were older, more often female, had poorer pre-fracture function, and greater comorbidity burden (all <i>p</i> < 0.001). Indoor falls were independently associated with higher risks of functional dependence (adjusted OR 1.19, 95% CI 1.01-1.40, <i>p</i> = 0.043), gait impairment (adjusted OR 1.34, 95% CI 1.18-1.52, <i>p</i> < 0.001), and mortality (adjusted HR 2.27, 95% CI 1.45-3.54, <i>p</i> < 0.001). Discharge destination and postoperative complications were not significantly associated with fall location after full adjustment. Associations were attenuated after adjustment for demographic and clinical factors, but those for functional dependence, gait impairment, and mortality remained significant.<h4>Conclusion</h4>Patients sustaining indoor falls represent a vulnerable subgroup with poorer functional recovery and higher mortality after fragility hip fractures. Fall location may serve as an additional marker of frailty and postoperative risk, contributing to risk stratification following hip fracture.
Background
This paper addresses the clinical question of how fall location relates to postoperative outcomes in adults with fragility hip fractures. Prior research indicated that fall location might reflect underlying vulnerabilities, but its specific association with outcomes such as functional dependence and mortality was not well established. Understanding this relationship is crucial for improving risk stratification and management of patients following hip fractures.
Methods
This retrospective multicentre cohort study analyzed data from the Korean Hip Fracture Registry, including patients aged ≥50 years with proximal femoral fractures treated between June 2016 and December 2024. Fall location was classified as indoor or outdoor. Primary outcomes included functional dependence, gait impairment, and mortality, while secondary outcomes included postoperative complications and discharge destination. Logistic regression and Cox proportional hazard regression were used to analyze outcomes, with adjusted odds ratios and hazard ratios calculated.
Results
Among 5,391 patients, 3,480 (64.6%) sustained indoor falls. Indoor fallers were older, more often female, and had poorer pre-fracture function (all p<0.001). Indoor falls were associated with functional dependence (adjusted OR 1.19, 95% CI 1.01-1.40, p=0.043), gait impairment (adjusted OR 1.34, 95% CI 1.18-1.52, p<0.001), and mortality (adjusted HR 2.27, 95% CI 1.45-3.54, p<0.001). Discharge destination and postoperative complications were not significantly associated with fall location after full adjustment.
Interpretation
The findings suggest that indoor falls are linked to poorer postoperative outcomes, aligning with previous literature that associates fall location with vulnerability. However, the effect sizes for functional dependence and gait impairment, while statistically significant, may not be clinically meaningful. The study's retrospective design and reliance on registry data introduce potential confounds that limit the conclusions drawn about causality and generalizability.
Key findings
- Indoor falls were independently associated with higher risks of functional dependence (adjusted OR 1.19, 95% CI 1.01-1.40, p=0.043).
- Indoor falls were independently associated with higher risks of gait impairment (adjusted OR 1.34, 95% CI 1.18-1.52, p<0.001).
- Indoor falls were independently associated with higher risks of mortality (adjusted HR 2.27, 95% CI 1.45-3.54, p<0.001).
- Mean follow-up was approximately six months.
- Most indoor falls occurred at home (80.8%).
- Discharge destination and postoperative complications were not significantly associated with fall location after full adjustment.
Limitations
- Retrospective study design.
- Relies on registry data, which may have unreported confounding factors.
- Potential biases from observational nature.
- Short follow-up period of approximately six months.