Prognosis

Hip fractures carry an approximately 30% risk of mortality at 1 year, and 25% to 75% of community-dwelling adults may not regain their prefracture level of function.[31][133][134][135][136][137][138] However, for some of the most vulnerable patients with hip fractures (i.e., nursing home residents), the 6-month mortality is as high as 36% (and 46% for men).[17] Predictors of mortality include significant comorbid disease, low pre-injury cognitive function, abnormal preoperative ECG, age >85 years, and decreased prefracture mobility.[139][140]

Meta-analyses have suggested that early surgery is associated with reduced mortality and complications.[62][63]

Patients with a positive affect who are in good health and live with someone have a better prognosis.[133][137] Older age, frailty, and increasing length of hospital stay result in a poorer prognosis and outcome with respect to return to prefracture functional status.[133][141]

One retrospective cohort study showed that nursing home residents with hip fractures and advanced dementia had a lower mortality rate when treated surgically compared with those who were managed nonsurgically, highlighting the need to balance expected outcomes alongside patient goals of care and comorbidities.[142]

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