The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery.

MORTALITY risk factors; RISK assessment; PHYSICAL therapy; HIP fractures; TOTAL hip replacement; ACADEMIC medical centers; SEX distribution; RESIDENTIAL patterns; EARLY ambulation (Rehabilitation); DESCRIPTIVE statistics; AGE distribution; HOME environment; HOSPITAL mortality; LONGITUDINAL method; BONE fractures; NURSING care facilities; DISEASES; SURGICAL complications; POSTOPERATIVE period; CONFIDENCE intervals; DATA analysis software; LENGTH of stay in hospitals; COMPARATIVE studies; TIME; PROPORTIONAL hazards models; RANGE of motion of joints; OLD age

Objective: To determine the association between the extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture. Design: Cohort study Setting: Acute orthopaedic hospital ward Participants: Consecutive sample of 701 patients, 65 years of age or older, 80% from own home, 49% with a trochanteric fracture, and 61% with an American Society of Anesthesiology grade > 2. Intervention: n/a Main measures: Cumulated ambulation score (CAS) (0-6 points) on the first postoperative day and 30-day postoperative mortality. A CAS = 0 reflects no functional mobility (bedridden), while a CAS = 6 reflects independent out-of-bed-transfer, chair-stand, and indoor walking status. Results: Overall, 86% of patients were mobilised to standing or seated in chair (CAS ≥ 1) on the first postoperative day. A CAS of 0, 1–3, and 4–6 was observed for 97 (14%), 519 (74%), and 85 (12%) patients, respectively. Overall, 61 (8.7%) patients died within 30 days with the highest mortality (23.7%, n = 23) seen for those not mobilised (CAS = 0). Only one patient (1.2%) with a CAS of 4–6 points died. Cox regression analysis adjusted for age, sex, residential status, pre-fracture CAS, fracture type, and American Society of Anesthesiology grade, showed that a one-unit increase in CAS was associated with a 38% lower risk of 30-day mortality (Hazard Ratio = 0.63, 95%Confidence Interval, 0.50–0.78). Conclusion: Mobility on the first postoperative day was associated with 30-day postoperative mortality, with a lower risk observed for those completing greater mobility. National registries may consider extending collection of mobility on the first postoperative day from a binary indicator to the CAS which captures the extent of mobility achieved. [ABSTRACT FROM AUTHOR]

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