Discharge after hip fracture surgery by mobilisation timing: secondary analysis of the UK National Hip Fracture Database

Abstract

Objective To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30 days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death. Method We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between 1 January 2014 and 31 December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 h of surgery) and those mobilised late, accounting for potential confounders and the competing risk of in-hospital death. Results A total of 106,722 (79%) of patients first mobilised early. The average rate of discharge was 39.2 (95% CI 38.9–39.5) per 1,000 patient days, varying from 43.1 (95% CI 42.8–43.5) among those who mobilised early to 27.0 (95% CI 26.6–27.5) among those who mobilised late, accounting for the competing risk of death. By 30-day postoperatively, the crude and adjusted odds ratios of discharge were 2.36 (95% CI 2.29–2.43) and 2.08 (95% CI 2.00–2.16), respectively, among those who first mobilised early compared with those who mobilised late, accounting for the competing risk of death. Conclusion Early mobilisation led to a 2-fold increase in the adjusted odds of discharge by 30-day postoperatively. We recommend inclusion of mobilisation within 36 h of surgery as a new UK Best Practice Tariff to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.

Impact of COVID-19 on hip fracture care in Ireland: findings from the Irish Hip Fracture Database

“…This may have been related to the shorter length of stay noted in this study cohort and also due to the redeployment of many key specialties during this time including geriatricians and physiotherapists. There have been many publications about the benefits of early mobilisation in hip fracture patients and as a consequence this was introduced as a new standard (IHFS 7) at the start of 2020 [10,11].…”

Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients—An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU)

“…The first key finding points out that early mobilization in an interdisciplinary care setting of older adult hip fracture patients is improved by increased geriatric involvement. Other health services report mobilization rates from 43% to 79% in the first 36–48 h after hip fracture surgery in an usual care setting [ 10 , 21 ]. This is of particular importance, as short-term muscle disuse could lead to muscle atrophy and sarcopenia, which accumulates throughout an individuals´ lifespan [ 22 ].…”

“…As walking ability was one of the main outcome parameters, this could have affected these results. Despite that, regaining mobility after a proximal femur fracture depends on various factors, the beneficial impact of early mobilization, physiotherapy and specific orthogeriatric treatment approaches was already shown [ 9 , 10 ]. Some variables were only dichotomously recorded (yes/no), which only allows a basic assessment of these parameters, but no further evaluation (e.g., postoperative degree of ambulation).…”

“…Various parameters seem to play a crucial role in the recovery process of orthogeriatric patients, such as previous walking ability or the occurrence of complications like decubitus or delirium [ 8 ]. Early mobilization with full weight-bearing is of major importance in the postoperative course, as weight-bearing restrictions reduce mobility and early mobilization increases odds for discharge by 30-day postoperatively [ 9 , 10 ]. Moreover, the initiation of an osteoporosis therapy showed significant impact on mortality and secondary fracture prevention in patients with osteoporosis related fractures [ 11 ].…”

The impact of the frequency, duration and type of physiotherapy on discharge after hip fracture surgery: a secondary analysis of UK national linked audit data

“…We adjusted for variables with a reported association with our study outcome: age [18], sex [18], ethnicity (White, Black or mixed Black, Asian or mixed Asian) [18], deprivation quintiles [18], ASA grade [16], CCI [14], Hospital Frailty Risk Score (low, intermediate, high risk) [15], pre-fracture residence (own home/sheltered housing, nursing care/residential care) [18], fracture type (intracapsular, intertrochanteric/subtrochanteric) [18], prefracture mobility (mobile outdoors with/without aids, some indoor mobility but never goes outdoors without help, no functional mobility) [18], type of anaesthetic (general, spinal) [19], type of surgery (internal fixation, hemiarthroplasty, total hip arthroplasty) [18], timing of surgery (within 36-h target, beyond target) [18], timing of first mobilisation (day of/after surgery, beyond 2 days of surgery) [18], and day of admission (weekday, weekend) [18].…”