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      Increased 1-year survival and discharge to independent living in overweight hip fracture patients

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          Abstract

          Background and purpose — Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively.

          Patients and methods — This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living.

          Results — Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22–26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2–5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4–5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22–26.

          Interpretation — In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture.

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          Most cited references19

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          Mortality following hip fracture: trends and geographical variations over the last 40 years.

          Hip fractures are an ever increasing cause of morbidity and mortality. Treatment of this condition requires an all-encompassing approach from prevention to post-operative care. It is important in such a situation to gather data on the incidence and trends of hip fractures to aid in the future treatment planning of this important condition. A review of all articles published on the outcome after hip fracture over a four decade period (1959-1998) was undertaken to determine any changes that had occurred in the demographics of patients and mortality over this time period. The mean age of patients sustaining hip fractures was found to be steadily increasing over the study period at a rate of 1 year of age for every 5-year time period. The mean age in the 1960s was 73 years to a mean of 79 years in the 1990s. No notable differences were seen in the proportion of male patients over the years but a definite downward trend was noticed with regard to intracapsular fractures. The mortality at 6 and 12 months after injury remained essentially unchanged over the four decades reviewed. Mortality after a hip fracture remains significant, being 11-23% at 6 months and 22-29% at 1 year from injury. Geographical variations exist in the mortality after hip fracture. More detailed international comparisons are required to determine if these differences in outcome are accounted for by the variations in the demographics of patients or due to diversities in treatment methods.
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            Survival and functional outcomes after hip fracture among nursing home residents.

            Little is known regarding outcomes after hip fracture among long-term nursing home residents.
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              The obesity paradox in surgical intensive care unit patients.

              To investigate the possible impact of obesity, as assessed by body mass index (BMI), on outcome in surgical intensive care unit (ICU) patients. Prospectively collected data from all consecutive adult patients admitted to our ICU between January 2004 and January 2009 were analysed retrospectively. BMI was calculated using the formula: BMI = body weight/height(2) (kg/m(2)), and patients were grouped as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), obese (30-39.9 kg/m(2)) and very obese (≥40 kg/m(2)). Among the 12,938 patients who were admitted to our ICU during the study period, 9,935 (76.8%) had complete height and weight data and constituted the study group. The mean BMI was 27.1 ± 5.0 kg/m(2). Overall, 34.4% of the study population had normal BMI, 1.8% were underweight, 41.2% were overweight, 20.8% were obese and 1.8% were very obese. The ICU mortality rate was similar among BMI subgroups, but hospital mortality was higher in underweight patients than in patients with normal BMI (17.8% versus 11.1%, P = 0.006). On multivariate Cox regression analysis, being overweight [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.74-0.99, P = 0.047] or obese (HR = 0.83, 95% CI = 0.69-0.99, P = 0.047) was independently associated with lower 60-day in-hospital mortality, with normal BMI as the reference category. Risk of death increased in very obese patients, especially after neurosurgical procedures (HR = 0.3, 95% CI = 1.06-8.48, P = 0.039). In this cohort of surgical ICU patients, being overweight or obese was associated with decreased risk of 60-day in-hospital mortality.
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                Author and article information

                Journal
                Acta Orthop
                Acta Orthop
                IORT
                Acta Orthopaedica
                Taylor & Francis
                1745-3674
                1745-3682
                April, 2016
                09 January 2016
                : 87
                : 2
                : 146-151
                Affiliations
                [1 ]Department of Geriatric Medicine, Karolinska University Hospital, Huddinge
                [2 ]Department of Clinical Science, Intervention and Technology (CLINTEC)
                [3 ]Karolinska Institute, Stockholm
                [4 ]Department of Neurobiology, Care Sciences and Society
                [5 ]Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala
                [6 ]Department of Orthopedics, Karolinska University Hospital, Huddinge, Sweden
                Author notes
                Article
                iort-87-146
                10.3109/17453674.2015.1125282
                4812076
                26986549
                f00ded25-c8a9-437d-944d-3d2ab0a1fa68
                © 2016 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License ( https://creativecommons.org/licenses/by-nc/3.0)

                History
                : Received on April 14, 2015
                : Accepted on September 29, 2015
                Categories
                Hip

                Orthopedics
                Orthopedics

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