Effects of impairment in activities of daily living on predicting mortality following hip fracture surgery in studies using administrative healthcare databases

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• 作者：Dallas P Seitz (1)
  Geoffrey M Anderson (2) (3)
  Peter C Austin (2) (3)
  Andrea Gruneir (2) (3) (4)
  Sudeep S Gill (5) (6)
  Chaim M Bell (2) (3) (7)
  Paula A Rochon (2) (3) (4)
  
• 关键词：Hip fracture ; Predictive models ; Mortality ; Outcomes ; Activities of daily living ; Confounding ; Risk adjustment
• 刊名：BMC Geriatrics
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：217 KB
• 作者单位：Dallas P Seitz (1)
  Geoffrey M Anderson (2) (3)
  Peter C Austin (2) (3)
  Andrea Gruneir (2) (3) (4)
  Sudeep S Gill (5) (6)
  Chaim M Bell (2) (3) (7)
  Paula A Rochon (2) (3) (4)
  
  1. Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  4. Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
  5. Department of Medicine, Queen’s University, Kingston, Ontario, Canada
  6. Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, Ontario, Canada
  7. Department of Medicine, Mt. Sinai Hospital, Toronto, Ontario, Canada
  
• ISSN：1471-2318

文摘

Background Impairment in activities of daily living (ADL) is an important predictor of outcomes although many administrative databases lack information on ADL function. We evaluated the impact of ADL function on predicting postoperative mortality among older adults with hip fractures in Ontario, Canada. Methods Sociodemographic and medical correlates of ADL impairment were first identified in a population of older adults with hip fractures who had ADL information available prior to hip fracture. A logistic regression model was developed to predict 360-day postoperative mortality and the predictive ability of this model were compared when ADL impairment was included or omitted from the model. Results The study sample (N--,329) had a mean age of 85.2?years, were 72.8% female and the majority resided in long-term care (78.5%). Overall, 36.4% of individuals died within 360 days of surgery. After controlling for age, sex, medical comorbidity and medical conditions correlated with ADL impairment, addition of ADL measures improved the logistic regression model for predicting 360 day mortality (AIC--706.9 vs. 1695.0; c -statistic--.65 vs 0.67; difference in - 2 log likelihood ratios: χ2--6.9, p--.002). Conclusions Direct measures of ADL impairment provides additional prognostic information on mortality for older adults with hip fractures even after controlling for medical comorbidity. Observational studies using administrative databases without measures of ADLs may be potentially prone to confounding and bias and case-mix adjustment for hip fracture outcomes should include ADL measures where these are available.