Factors affecting time to surgery and mobilization following hip fracture

Introduction

Faster time to operative fixation and mobilization decreases morbidity and mortality for hip fracture patients. Many hospitals are working at or above their capacity and beds in surgical floors for surgical patients may not be available. The purpose of this study was to determine if the floor of admission after a hip fracture impacts time to surgical fixation and time to mobilization after surgery.

Methods

781 patients over the age of 50 who underwent hip fracture surgery between January 2011 and January 2021 were included in this analysis. Patient demographics, injury characteristics and floor of admission were collected and analyzed. Time of diagnosis was defined as the time of the initial presenting radiograph, and time of mobilization was defined as the time the patient stood at edge of bed with physical therapy. Floor of admission is determined based on admitting service (medicine, orthopaedics, trauma surgery) as well as bed availability. Floors were considered surgical or non-surgical based on standard patient populations.

Results

Time to surgery from diagnosis was significantly longer on nonsurgical floors (28 vs. 22 hours p = 0.003). Time from surgery to mobilization out of bed was significantly shorter for patients on surgical floors (53 vs. 63 hours, p = 0.01). There was no difference in time to evaluation by physical therapy (p = 0.8). Time from diagnosis to surgery and time from surgery to injury was not different across patient races or language spoken.

Conclusions

Patients admitted to non-surgical floors had a significantly longer time to surgery as well as longer time to mobilization compared to patients who were admitted to surgical floors. Time to physical therapy evaluation following surgery was the same, suggesting different factors such as medical comorbidities, staff training, and resource availability likely contribute to the significant difference in time to mobilization. Race and language did not play a role in delaying time to the operating room or mobilization with physical therapy.