Is prescribed lower extremity weight-bearing status after geriatric lower extremity trauma associated with increased mortality? 2018

Ida Leah Gitajn, and Daniel Connelly, and Daniel Mascarenhas, and Stephen Breazeale, and Peter Berger, and Carrie Schoonover, and Brook Martin, and Robert V O'Toole, and Raymond Pensy, and Marcus Sciadini
Dartmouth Hitchcock Medical Center, Department of Orthopaedic Surgery, Dartmouth Geisel School of Medicine, Hanover, NH, United States. Electronic address: Ida.Leah.Gitajn@hitchcock.org.

OBJECTIVE Evaluate whether mortality after discharge is elevated in geriatric fracture patients whose lower extremity weight-bearing is restricted. METHODS Retrospective cohort study SETTING: Urban Level 1 trauma center PATIENTS/PARTICIPANTS: 1746 patients >65 years of age INTERVENTION: Post-operative lower extremity weight-bearing status MAIN OUTCOME MEASURE: Mortality, as determined by the Social Security Death Index RESULTS: Univariate analysis demonstrated that patients who were weight-bearing as tolerated on bilateral lower extremities (BLE) had significantly higher 5-year mortality compared to patients with restricted weight-bearing on one lower extremity and restricted weight-bearing on BLE (30%, 21% and 22% respectively, p < 0.001). Cox regression analysis controlling for variables including age, Charlson Comorbidity Index, Injury Severity Scale, combined UE/LE injury, injury mechanism (high vs low), sex, BMI and GCS demonstrated that, in comparison to patients who were weight bearing as tolerated on BLE, restricted weight-bearing on one lower extremity had a hazard ratio (HR) of 0.97 (95% confidence interval 0.78 to 1.20, p = 0.76) and restricted weight-bearing in BLE had a HR of 0.91 (95% confidence interval 0.60 to 1.36, p = 0.73). CONCLUSIONS In geriatric patients, prescribed weight-bearing status did not have a statistically significant association with mortality after discharge, when controlling for age, sex, body mass index, medical comorbidities, Injury Severity Scale (ISS), mechanism of injury, nonoperative treatment and admission GCS. This remained true in when the analysis was restricted to operative injuries only.

UI MeSH Term Description Entries
D007869 Leg Injuries General or unspecified injuries involving the leg. Injuries, Leg,Injury, Leg,Leg Injury
D008297 Male Males
D010351 Patient Discharge The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities. Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D014193 Trauma Centers Specialized hospital facilities which provide diagnostic and therapeutic services for trauma patients. Trauma Units,Center, Trauma,Centers, Trauma,Trauma Center,Trauma Unit,Unit, Trauma,Units, Trauma
D014505 Urban Population The inhabitants of a city or town, including metropolitan areas and suburban areas. Urban Residence,Urban Spatial Distribution,Distribution, Urban Spatial,Distributions, Urban Spatial,Population, Urban,Populations, Urban,Residence, Urban,Urban Populations,Urban Residences,Urban Spatial Distributions

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