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

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 = 1,329) 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 = 1,706.9 vs. 1,695.0; c-statistic = 0.65 vs 0.67; difference in -2 log likelihood ratios: chi² = 16.9, p = 0.002).

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.