Rehabilitacion · Oct 27, 2026
Factors associated with 120-day mortality, functional decline, and residential status following fragility hip fractures: a prospective cohort study
By Cuesta Miyares J, Vega Álvarez JA, Fernández Fuertes J
INTRODUCTION AND OBJECTIVE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.