Maren Paus

• Paus, Maren; Sundin, Ulf Gunnar; Sydnes, Kristian; Martinsen, Mette; Valland, Haldor & Sunde, Sylvia [Show all 9 contributors for this article] (2025). Functional outcomes and complication rates of the SPAIRE approach compared to the direct lateral approach in hemiarthroplasty for displaced femoral neck fractures. Injury. ISSN 0020-1383. 56(6), p. 112339–112339. doi: 10.1016/j.injury.2025.112339. Full text in Research Archive
• Sundet, Mads; Martinsen, Mette; Paus, Maren; Valland, Haldor; Halvorsen, Henriette Haugli & Sexton, Joseph [Show all 8 contributors for this article] (2025). Predictors of 1-year mortality in a clinical cohort of hip fracture patients. European Journal of Trauma and Emergency Surgery. ISSN 1863-9933. 51(1). doi: 10.1007/s00068-025-02812-y. Full text in Research Archive
• Sundet, Mads; Sundin, Ulf Gunnar; Godø, Aasmund; Sydnes, Kristian; Valland, Haldor & Sexton, Joseph [Show all 10 contributors for this article] (2024). Use of direct-acting anticoagulants (DOACs) delays surgery and is associated with increased mortality in hip fracture patients. European Journal of Trauma and Emergency Surgery. ISSN 1863-9933. doi: 10.1007/s00068-024-02532-9. Full text in Research Archive Show summary

  Purpose Treatment with direct-acting oral anticoagulants (DOACs) is increasing among hip-fracture patients, with accompanying safety concerns regarding spinal anesthesia (SA). The aim of this study was to investigate if DOAC use is associated with increased waiting time before surgery, increased mortality, or other adverse events. Methods Registry data on surgically treated hip-fracture cases at a single hospital between 2015 and 2021 were analyzed. Multivariable regression analyses were performed with DOAC-status and choice of anesthesia as exposures, and waiting time, length of stay, transfusion, and mortality as outcomes. Results 2885 cases were included, 467 patients (16%) were using DOACs. DOAC users were older (86.3 vs. 82.2 years, p < 0.001), had a higher Charlson Comorbidity Index (2.1 vs. 1.5, p < 0.001) and had longer median time to surgery than non-DOAC cases (36 h vs 17 h, p < 0.001). General anesthesia (GA) was used in 19.3% of DOAC patients and in 3.0% of non-DOAC patients. DOAC-patients had an increased risk of one-month mortality (Adjusted Odds Ratio (AOR) 1.6 (1.1–2.3)) and one-year mortality (AOR 1.4 (1.1–1.8)). There were no differences in risk of blood transfusion. Patients on DOAC operated under GA had a lower risk of one-year mortality (AOR 0.5 (0.3–0.9)), but a similar one-month mortality to DOAC-patients operated under SA. Conclusion DOAC users had a longer waiting time to surgery, indicating postponement of surgery due to concerns of the safety of SA. The clinical practice should be changed to allow earlier surgery for DOAC patients.

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• Sunde, Sylvia; Ranhoff, Anette Hylen; Sundet, Mads; Sundin, Ulf Gunnar; Lillegraven, Siri & Paus, Maren [Show all 8 contributors for this article] (2024). Predictors for physical function three months after hip fracture surgery in older adults. Full text in Research Archive Show summary

  Aims: Many patients have a substantial reduction in physical function after suffering a hip fracture. This study aimed to identify baseline factors associated with decreased physical function three months after hip fracture surgery in older adults. Methods: Data was retrieved from a quality database including patients admitted to a general hospital in Oslo, Norway due to a hip fracture between 2014 and 2023. All patients 65 years or older who attended the three-month physiotherapy follow-up were included. Physical function was assessed by the Short Physical Performance Battery (SPPB). A multivariate linear regression analysis was performed with SPPB as outcome variable, and age, sex, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists score (ASA), pre-fracture New Mobility Score (NMS), and osteosynthesis vs arthroplasty as predictor variables. Results: 1661 cases were included in the analyses. The mean age of the patients was 81.8 (SD 8.1) years; 1196 (72%) were female. The mean score on the SPPB 3 months after surgery was 6.3 (SD 3.5) points. 832 (50%) were treated with hemiarthroplasty or total hip arthroplasty, whereas 829 (50%) were treated with osteosynthesis. Multiple regression analysis showed positive associations between pre-fracture NMS and SPPB, β 0.82 (95% CI 0.74 to 0.89). In the same model, we observed negative associations between SPPB and the other explanatory variables, age [β -0.09 (95% CI -0.11 to -0.07)], ASA score [β -0.59 (95% CI -0.88 to -0.30)], and CCI [β -0.21 (95% CI -0.36 to -0.06)]. Furthermore, being treated with osteosynthesis was negatively associated with SPPB, β -0.60 (95% CI -0.89 to -0.31). There was a trend towards worse physical function in men compared to women, β -0.32 (95% CI -0.65 to 0.01). Conclusion: Patients with higher age, lower pre-fracture physical function measured by NMS, higher ASA score, higher Charlson Comorbidity score, or who are treated with osteosynthesis are at higher risk of worse physical function three months after hip fracture. This frail group should be offered extensive rehabilitation services while hospitalized and in the first months after discharge. The results can help healthcare providers optimize treatment for patients with a higher risk of low physical function following hip fractures.

• Hesseberg, Karin; Ranhoff, Anette Hylen; Sundet, Mads; Sundin, Ulf Gunnar; Lillegraven, Siri & Martinsen, Mette [Show all 8 contributors for this article] (2024). Two out of three do not regain mobility the first three months after hip fracture: A longitudianl study. Full text in Research Archive Show summary

  Aim: Hip fracture is a risk factor for functional impairment, loss of independence, and death. Significant costs are associated with the treatment of older individuals with hip fractures. Increased knowledge entailing functional impairment is valuable in the development and initiation of healthcare services for this group of frail older adults. The aim of this study was to investigate to what degree hip fracture patients regained their mobility 3 months after injury. Method: Data were retrieved from a quality database containing information regarding all patients treated for a hip fracture at a hospital in Oslo, Norway between 2014 and 2023. The study included patients who were 65 years or older when admitted, with data available on the New Mobility Score (NMS) from the pre-fracture status (collected at the initial hospital stay) and three-months post-operatively. Pre- and three-month post injury NMS scores were compared using t-tests of differences of means. Logistic regression analysis was used to explore factors associated with the probability of regaining mobility (NMS three-months post injury). Results: 1309 patients, 935 (71%) women and 374 (29%) men with a mean age of 81.6 (SD 8.2) years were included. The mean NMS before the fracture was 7.2 (SD 2.2) points, and the mean score three months after the surgery was 5.4 (SD 2.4) points. The mean decrease in NMS scores was 1.8 points (95% CI 1.7 to 1.9), (p < 0.001). 341 (26%) patients had the same score at follow-up as before the fracture, 109 (8%) patients improved their score by at least one point, and 859 (66%) patients had a score at least one point lower as before the fracture. The results from the logistic regression analysis showed statistically significant associations between mobility and the factors age, American Society of Anaesthesiologists score (ASA) at baseline, type of operation and pre-fracture mobility. Patients with higher age, higher ASA score at baseline, and lower pre-fracture mobility had lower odds of regaining mobility; OR 0.94 (95% CI 0.93 to 0.96), 0.73 (95% CI 0.57 to 0.93), and 0.73 (95% CI 0.69 to 0.78), respectively. In addition, those who were treated with osteosynthesis had lower odds of regaining mobility compared with those who were treated with arthroplasty 2.02 (95% CI 1.57 to 2.59). Ninety percent (1180/1305) of the patients reported that they had been seen by a physiotherapist after discharge. Conclusion: The results show a reduction in mobility three months after the hip fracture, compared to status pre-fracture. Although 90% of the patients had been seen by a physiotherapist after discharge, only one-third of the patients had regained their pre-fracture level of mobility three months after treatment. The results indicate a potential for improved rehabilitation interventions in the first three months after a hip fracture. Patients at risk of not regaining their mobility should get a special focus.

• Paus, Maren (2024). Trender i hoftebruddspopulasjonen ved Diakonhjemmet 2006-2023. Full text in Research Archive Show summary

  Paus M, Sundin U, Martinsen M, Ranhoff AH, Sundet M.

• Paus, Maren (2024). BETTER FUNCTIONEL OUTCOME FOR PATIENTS OPERATED WITH SPAIRE APPROACH WHEN SUFFERING FROM A FEMORAL NECK FRACTURE. Full text in Research Archive Show summary

  M. Paus, U. Sundin, S. Lillegraven, M. Sundet, K. Sydnes, S. Sunde, M. Martinsen. Aim Displaced femoral neck fractures are usually treated with hemiarthroplasty. The direct lateral (Hardinge) approach has been regarded as the standard surgical approach and is recommended in several current guidelines. There is a concern that the lateral approach is associated with limping and reduced gluteal function, and a muscle sparing posterior approach, SPAIRE (Saving Piriformis And Internus Repair Externus) has been developed. This approach is hypothesized to improve hip function, reduce pain and maintain a low risk of prosthesis dislocation. The aim of this study was to compare the lateral approach and the SPAIRE approach, with both complication rates and physical function as outcomes. Methods From September 2018 our department gradually changed our standard surgical approach for hemiarthroplasties from the direct lateral approach to the SPAIRE approach. All patients were registered in our local hip fracture database. Community-dwelling patients were invited to a follow-up by a physiotherapist 3 months after the admission, and results from functional tests including New Mobility Score (NMS) and Short Physical Performance Battery (SPPB) were recorded. Other outcomes were prosthesis dislocation, surgical site infection, and 30-day mortality. Continuous outcomes were analyzed with linear regression, while dichotomous outcomes were evaluated through logistic regression and contingency tables. Results Between September 2018 and November 2022, 858 cases were operated; 430 patients with the direct lateral approach and 428 patients with the SPAIRE approach. There were no differences between the groups in prosthesis dislocation rate (SPAIRE 0.7% vs direct lateral 0.9%, p=0.725), surgical site infections (SPAIRE 3.27% vs direct lateral 3.97% p =0.589) or 30-day mortality rate (SPAIRE 6.74% vs direct lateral 8.64%, p=0.308). 43% of the patients had a 3 month follow-up (SPAIRE n=192; direct lateral n=180). At this time point, the SPAIRE group had better results in all functional tests/outcome measures for physical function: NMS: 6.1 vs 5.0 points (p<0.001), NMS change from preoperative: -1.3 vs -1.8 points (p=0.024), SPPB: 7.3 vs. 5.9 points (p<0.001), preferred walking speed: 0.8 vs 0.7 m/s (p<0.001). Conclusions Our findings indicate that patients operated with the SPAIRE approach may have a better functional outcome compared to those operated with standard direct lateral approach, while we found no differences in post-operative complications. The low percentage of patients attending the 3-month follow-up and the historic control design may have introduced biases, and a randomized, controlled study is warranted.

• Nellemann, Birgitte & Paus, Maren (2023). Osteoporose, smerte, artrose. Full text in Research Archive
• Paus, Maren (2023). Overvekt og fedme blant hoftebruddpasienter. Full text in Research Archive Show summary

  Maren Paus, Mads sundet, Siri Lillegraven, Mette Marthinsen. Bakgrunn: Overvekt og fedme beskrives ofte som en risikofaktor for komplikasjoner og dårligere utfall. Bakgrunnen for denne studien var å beskrive fordelingen av BMI i en stor hoftebruddkohort, og å analysere assosiasjoner mellom BMI og 1 års overlevelse. Metode: Data fra Diakonhjemmets Hoftebruddregister ble analysert, i dette registeret er alle hoftebrudd behandlet på Diakonhjemmet etter 2006 registrert. Mortalitetstall er hentet fra folkeregisteret Resultat: 4049 hadde registrert BMI ved innleggelse. Flere pasienter med kognitiv svikt manglet opplysninger om BMI enn kognitivt friske. I henhold til WHO`s klassifikasjon var 15,2% undervektige, 60,0% var normalvektige, 19,9 % var overvektige, 3,7% hadde fedme grad 1 og 1,1% hadde fedme grad 2 eller høyere. Menn hadde høyere BMI enn kvinner (1.0 enhet, 95% CI 0.7-1.3) og pasienter med diabetes hadde høyre BMI enn de uten diabetes (2,4 enheter, 95%CI 1,9-2,9) I en multivariabel logistisk regresjons modell var det signifikant høyere 1 års overlevelse hos pasienter med overvekt (AOR 0.6, 95% CI 0.4-0.8) og for pasienter med fedme grad 1 (AOR 0.4, 95% CI 0.2-0.8) sammenlignet med normalvektige. Pasienter som var undervektige hadde høyest risiko for død (AOR 2.3, 95% CI 1.7-3.0). Konklusjon: Vi finner et «fedmeparadoks» hvor pasienter med overvekt og fedme grad 1 har bedre overlevelse enn normalvektige. Undervekt var sterkt assosiert med forhøyet dødelighet.

• Paus, Maren (2023). Overweight and obesity in hipfracture patients. A blessing or a curse? Full text in Research Archive Show summary

  Maren Paus, Mads Sundet, Siri Lillegraven, Mette Martinsen. Aim: Overweight and obesity is generally viewed as a risk factor for complications and poor outcomes. The aim of this study was to describe the distribution of BMI in a large hip fracture cohort, and to investigate associations between BMI and 1-year mortality. Methods: Analysis of data from the Diakonhjemmet Hip Fracture Database, where all hip fractures presenting to the hospital has been prospectively registered since 2006. Mortality data were collected from the National Population Register. Results: 4049 patients had their BMI recorded. Patients with dementia had more missing values for BMI. According to the WHO classification, 15.2% were underweight, 60.0 % were normal weight, 19,9% were overweight, 3.7% were class 1 obese, and 1,1% were class 2 obese or higher. Males had higher BMI than females (1.0 unit, 95% CI 0.7-1.3) and diabetic patients had higher BMI than non-diabetic patients (2.4 units, 95% CI 1.9-2.9). In a multivariate logistic regression model, there were significantly better 1-year survival for overweight (OR 0.6, 95% CI 0.4-0.8) and class 1 obese patients (OR 0.4, 95% CI 0.2-0.8) compared to normal weight, while underweight patients had the highest risk of death (OR 2.2, 95% CI 1.7-2.9). Conclusion: We demonstrate an “obesity paradox”, where patients with overweight and class 1 obesity have better 1-year survival than patients with normal weight. Underweight was a strong risk factor for mortality.

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