Delayed Postoperative Ambulation Results in a Significant Increase in 90-Day Mortality in Surgically Treated Hip Fractures.

Abstract

Introduction: Hip fractures in individuals aged 65 and older present a significant burden to patients, families, and health care systems. These fractures lead to increased morbidity, loss of autonomy in Activities of Daily Living (ADLs), prolonged hospitalization, and heightened mortality rates. Despite existing knowledge, there is a need for high-quality studies to understand mid- to long-term outcomes and the impact of postoperative variables on mortality.

Methods: This retrospective matched case-control study analyzed patients who underwent operative management for hip fractures between August 1, 2021, and August 1, 2023, at a single Level II trauma center. Cases were defined as patients who expired between postoperative day 1 and ninety, while controls were patients alive at postoperative day 90. Cases and controls were matched by sex and age at the time of surgery. Patients over age 60, who underwent surgical treatment of a femoral neck or intertrochanteric fracture after receiving a preoperative block and were able to ambulate prior to their injury included. Cases and controls were matched based upon patient demographics including comorbidities. Major matched comorbidities were diabetes mellitus, hypertension, Chronic Obstructive Pulmonary Disease, and Coronary Artery Disease. A logistic regression was used to measure the association between in-hospital mobility and 90-day mortality.

Results: The 90-day mortality rate was 9.5% (16/169). The mean age of participants was 85.7 years, with 62.5% female. No significant differences were found in hospital length of stay or operative time. However, 37.5% of cases were discharged on hospice compared to 3.1% of controls. Only 6.3% of cases ambulated in the hospital compared to 53.1% of controls (P-value <.001). Logistic regression indicated that the odds of death were 17 times higher in patients who did not walk during their hospital stay (OR: 17.0, 95% CI: 2.91-326.0, P-value: 0.01).

Conclusions: This study highlights the critical importance of early postoperative mobilization in reducing 90-day mortality in hip fracture patients. The findings reveal that patients who ambulated during hospital admission had significantly lower mortality rates. These results suggest that early mobilization could serve as a strong protective factor against early postoperative mortality.