Frenkel Rutenberg Tal, Vitenberg Maria, Haviv Barak, Velkes Steven
Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 39 Jabotinsky St., 49100, Petah Tikva, Israel.
Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 7 Kakal St., 49327, Petah Tikva, Israel.
Arch Orthop Trauma Surg. 2018 Nov;138(11):1519-1524. doi: 10.1007/s00402-018-3010-1. Epub 2018 Jul 27.
Post-operative physiotherapy (PT) following fragility hip fractures is intended to improve balance, gait, and muscle strength for enhanced functional outcomes. This study aims to assess whether postponing initiation of PT effects patients' outcomes during hospitalization and in the first 3 months following discharge.
A retrospective study comparing consecutive patients, 65 years and older, who were operated for fragility hip fractures between 2011 and 2016, within 48 h from admission, and started PT treatment either in the first post-operative day (POD1) or later (POD2-5). Patients were operated upon as soon as medically possible and in accordance with theater availability. All surgeries were performed outside of workday hours (either in the afternoon or during the weekend). Group allocation was established corresponding with the surgical day, as PT services are unavailable during weekends and holidays, and surgeries were performed daily. Primary outcomes were mortality either within hospital or in the post-operative year. Secondary outcomes were in-hospital complications, recurrent hospitalizations, and orthopedic complications within 3 months.
747 patients were included in the study; 525 patients started PT at POD1 and 222 had delayed PT. Patients' demographics, living arrangements, age-adjusted Charlsons' co-morbidity index, mobility, hemoglobin levels, and implant type were comparable. In-hospital mortality was significantly higher for the delayed PT group, 6.8 vs. 3.2% (OR 2.2, 95% CI 1.06-4.42, p value 0.034). One-year mortality, in-hospital complications, and the average number of 3 months' recurrent hospitalizations did not differ between groups. A trend for more orthopedic complications was noted in the delayed PT group (p = 0.099), and patients from this group were readmitted more often due to orthopedic surgery-related reasons (p = 0.031).
Post-operative delay in PT following fragility hip fracture surgery was related to increased risk for in-hospital mortality.
脆性髋部骨折术后的物理治疗（PT）旨在改善平衡、步态和肌肉力量，以提高功能预后。本研究旨在评估推迟物理治疗的起始时间是否会影响患者在住院期间及出院后前3个月的预后。
一项回顾性研究，比较2011年至2016年间65岁及以上因脆性髋部骨折入院且在入院48小时内接受手术的连续患者，他们在术后第1天（POD1）或之后（POD2 - 5）开始接受物理治疗。患者在医学上尽可能早且根据手术室可用情况进行手术。所有手术均在非工作日时间（下午或周末）进行。由于周末和节假日没有物理治疗服务，且手术每天都有，因此根据手术日期进行分组。主要结局是住院期间或术后一年内的死亡率。次要结局是住院并发症、再次住院以及3个月内的骨科并发症。
747例患者纳入研究；525例患者在POD1开始物理治疗，222例延迟物理治疗。患者的人口统计学特征、生活安排、年龄校正的查尔森合并症指数、活动能力、血红蛋白水平和植入物类型具有可比性。延迟物理治疗组的住院死亡率显著更高，分别为6.8%和3.2%（比值比2.2，95%可信区间1.06 - 4.42，p值0.034）。两组之间的一年死亡率、住院并发症以及3个月内再次住院的平均次数没有差异。延迟物理治疗组有更多骨科并发症的趋势（p = 0.099），且该组患者因骨科手术相关原因再次入院的频率更高（p = 0.031）。
脆性髋部骨折手术后物理治疗的延迟与住院死亡率增加有关。
