Early Mobilization and Predictors of Delayed Disposition for Geriatric Hip Fractures.

Abstract

Objectives: To evaluate the effect of perioperative variables, including physical therapy (PT) and walking distance on length of stay (LOS) in hip fracture patients.

Methods:

Design: A retrospective review.

Setting: Single level I trauma center.

Patient selection criteria: Patients aged 65 years and above with hip fractures Orthopaedic Trauma Association/AO Foundation 31-A and 31-B) between 2017 and 2020 were included. Patients were excluded if they were treated nonoperatively, suffered periprosthetic fracture, or were not admitted under the hip fracture protocol.

Outcome measures and comparisons: Admission and perioperative variables including time to surgery and number of postoperative days (PODs) without a documented PT session during the first 3 PODs were assessed for correlation with increased total hospital LOS and postoperative LOS.

Results: There were 301 patients included [234 (77.7%) female] with an average age of 84.4 years (±8.1 years). The median total LOS was 5 (interquartile range, 3-7) days and 4 (interquartile range 3-6) days after surgical fixation. Thirty-seven percentage of hip fractures had a delay in discharge. Ninety-five percentage of patients were discharged to a rehabilitation facility. The highest percentage of days with no PT session occurred on Saturdays and Sundays with 43% and 34% on POD 1, respectively; 40% and 33% on POD 2; and 26% and 30% on POD 3; P = 0.0004. In multivariate analysis, longer total LOS was associated with time to surgery more than 24 hours [AOR 5.6; 95% confidence interval (CI), 1.8-17.4; P < 0.0030], major complication (AOR 8.26; 95% CI, 2.8-20.0; P < 0.0014), discharge to subacute rehab (AOR 5.6; 95% CI, 3.0-10.5; P < 0.0001), and walking < 5 feet or not receiving PT (among patients with no assistance required as prehospital ambulatory status) (AOR 6.0; 95% CI, 2.3-15.3; P < 0.02). Longer LOS after surgery was associated with major complication (AOR 11.2; 95% CI, 3.1-39.8; P < 0.0002), discharge to subacute rehab (AOR 5.0; 95% CI, 2.7-9.1; P < 0.0001), and walking < 5 feet or no PT (AOR 4.8; 95% CI, 2.0-11.5; P < 0.01).

Conclusions: Emphasis should be placed on minimizing complications while maximizing postoperative PT and early ambulation in the acute postoperative period, given the demonstrated association between inadequate mobilization and delayed disposition, especially if surgical fixation occurs surrounding the weekend or holiday.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.