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Prognosis of Functional Recovery 1 Year After Hip Fracture

Typical Patient Profiles Through Cluster Analysis

^a Department of Geriatrics, Divisions of
^b Orthopedics, University Hospitals of Geneva, Switzerland
^c Anesthesiology, University Hospitals of Geneva, Switzerland
^d Department of Geriatrics, District Hospital of Sierre, Switzerland
^e Department of Sociology and Center for Interdisciplinary Gerontology, University of Geneva, Switzerland

Jean-Pierre Michel, Department of Geriatrics, University Hospitals of Geneva, Route de Mon Id\|[eacute]\|e, CH-1226 Th\|[ocirc ]\|nex, Geneva, Switzerland E-mail: jean-pierre.michel{at}hcuge.ch.

Decision Editor: John E. Morley, MB, BCh

Background. Many investigators have identified distinct medical, demographic and psychosocial prefracture conditions that influence the functional outcome of patients surgically treated for a fracture of the hip. However, to design efficient intervention care programs addressing the needs of these patients, at optimal economic and social costs, more information is required on the typical combinations of prognostic determinants actually encountered.

Methods. Data on specific descriptors of the prefracture status and on mobility and functioning 1 year after surgical intervention were collected by interview from 253 consecutive patients hospitalized for a fracture of the proximal femur. Cluster analysis was used to form homogeneous groups of patients with similar profiles in terms of the 13 predictive variables and the 7 outcome variables significantly interrelated. The modeling procedure generated four clusters of patients with a typical profile sharply contrasted by their structure.

Results. Subjects of two clusters could walk without difficulty and were functionally independent prior to their hip fracture. One year later, however, mobility and functioning were only fully recovered by the members of one cluster. The majority of predictors were of less favorable prognostic value for the members of the second cluster. The other two clusters regrouped patients with impaired prefracture mobility that were either unaltered or even aggravated 1 year later.

Conclusions. Cluster analysis identified typical profiles of elderly hip fracture patients. Close scrutiny of their respective global structure, in terms of combined prognostic determinants and outcomes, may help to develop specific management strategies that are more efficiently adapted to these different groups of patients.

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