Authors
J Cuesta Miyares, J A Vega Álvarez, J Fernández Fuertes
Published in
Rehabilitacion. Pages 101019. Oct 27, 2026. Epub Oct 27, 2026.
Abstract
To identify predictors of 120-day mortality and to describe changes in walking capacity, residential status, and secondary fracture prevention following fragility hip fracture in older adults.Prospective longitudinal observational study. From 340 consecutive patients ≥75 years with fragility hip fractures, an analytical cohort of 324 surgically treated patients was defined. Cumulative 120-day mortality and its predictors (age, American Society of Anesthesiologists [ASA] physical status III-IV, surgical delay >48 hours, and preoperative moderate/severe malnutrition according to Global Leadership Initiative on Malnutrition [GLIM] criteria) were evaluated using unadjusted and multivariable binary logistic regression models (primary complete-case analysis, n=321). Changes in walking capacity, residential destination, and pharmacotherapy at 120 days were evaluated over the respective baseline populations at risk.
Of 340 patients, 324 underwent surgery (mean age 88.2 years, 74.1% women; ASA III-IV 82.7%). In 209 (64.5%), surgery was delayed >48 hours. At 120 days (0% loss to follow-up), 47 patients died (14.5% overall: 10.4% [12/115] in surgery ≤48 hours vs. 16.7% [35/209] in surgery >48 hours; unadjusted Odds Ratio [OR] 1.73, 95% CI 0.86-3.48; p=0.126). In the multivariable logistic regression model (n=321), preoperative moderate/severe malnutrition was independently associated with higher 120-day mortality (adjusted OR 4.80, 95% CI 2.14-10.78; p<0.001). After adjusting for age, ASA physical status III-IV, and preoperative malnutrition, surgical delay >48 hours was not statistically associated with mortality (adjusted OR 1.80, 95% CI 0.87-3.75; p=0.113), although the wide confidence interval does not exclude a clinically relevant risk. At 120 days, among pre-fracture independent walkers (n=303), 13.9% (42/303) transitioned to severe dependence/immobility, 72.3% (219/303) maintained independent walking, and 13.9% (42/303) had died. Among patients previously living at home (n=205), 38.0% (78/205) required de novo institutionalization, 48.3% (99/205) remained at home, and 13.7% (28/205) had died. Antiresorptive prescription increased from 2.8% at baseline to 5.8% among survivors.
Preoperative moderate/severe malnutrition was independently associated with increased 120-day mortality after adjusting for age, ASA physical status, and surgical delay. Surgical delay >48 hours was not statistically associated with 120-day mortality in unadjusted or adjusted analyses, although estimates were imprecise and residual confounding cannot be excluded. Loss of independent walking capacity and de novo institutionalization affected a substantial proportion of at-risk patients at 120 days, while antiresorptive prescription remained low.
PMID:
42946208
Bibliographic data and abstract were imported from PubMed on 28 Oct 2026.
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