Heterogeneity in postoperative intrinsic capacity trajectories in older adults with hip fractures: a prospective longitudinal study

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Objective: To investigate the group heterogeneity in postoperative intrinsic capacity (IC) recovery trajectories among older hip fracture (HF) patients and identify key independently associated factors. Methods: We conducted a prospective longitudinal study of 184 older patients following HF surgery at two tertiary hospitals. IC was assessed at 48 h, pre-discharge, 1 month, and 3 months post-surgery. A multi-state Markov model (MSM) was used to quantify transition intensity and probability between IC states, a latent class growth model (LCGM) was employed to identify heterogeneous trajectories of total IC scores, and predictors of trajectory categories were analyzed via multinomial logistic regression. Results: MSM revealed that patients in the "severe IC impairment" state had a 96.3% probability of remaining in that state throughout the 3-month follow-up. LCGM further identified three distinct recovery trajectories: the Higher-Level Growth Group (21.2%), the Medium-Level Improvement Group (36.9%), and the Lower-Level Stability Group (41.8%). Multivariate analysis indicated that age 60-69 years was significantly associated with increased odds of belonging to the Medium-Level Improvement Group (OR = 18.12, 95% CI: 4.22-77.86) and the Higher-Level Growth Group (OR = 3.33, 95% CI: 1.10-10.09) compared to the Lower-Level Stability Group. Normal plasma albumin was significantly associated with increased odds of belonging to the Medium-Level Improvement Group (OR = 7.07, 95% CI: 1.30-38.51). Conclusion: From a public health perspective, the identification of three distinct recovery trajectories provides an evidence-based framework for population-level risk stratification. The large subgroup (41.8%) with persistent severe impairment represents a high-risk population that may require targeted resource allocation for post-acute and long-term care. These findings support the development of tiered rehabilitation strategies at the health system level, aligning with the goals of healthy aging.

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