Effect of previous cerebrovascular accident on outcome after hip fracture

Objective: To evaluate the effect of previous cerebrovascular accident on o utcome after hip fracture. Study Design: Prospective, consecutive. Patients: From July 1987 to March 1997, 862 community-dwelling patients six ty-five years of age or older who had sustained an operatively treated femo ral neck or intertrochanteric fracture were prospectively followed. Intervention: All patients had operative fracture treatment. Main Outcome Measurements: Postoperative complications, in-hospital mortali ty, hospital length of stay, hospital discharge status, one-year mortality and place of residence, and return to preinjury ambulatory level, basic and instrumental activities of daily living status. Results: Sixty-three patients (7.3 percent) had a history of cerebrovascula r accident; the fracture was on the hemiplegic side in forty-six (86.8 perc ent) of the fifty-three patients with hemiplegia. Patients who had a histor y of cerebrovascular accident were more likely to be male and have an Ameri can Society of Anesthesiologists (ASA) rating of III or TV. They were also more likely to have three or more comorbidities, be a home ambulator, and b e dependent on basic and instrumental activities of daily living before hip fracture. Hospital length of stay was significantly higher for patients wh o had a history of cerebrovascular accident. There were no differences in t he incidence of hospital mortality or one-year mortality between patients w ho did and did not have a history of cerebrovascular accident before hip fr acture. In addition, at one-year follow-up, when controlling for prefractur e level of function, there were no differences in the rate of functional re covery between the two groups of patients. Conclusions: The functional recovery of elderly hip fracture patients who h ad a prior cerebrovascular accident was similar to that of patients who had no history of a prior cerebrovascular accident.