Fisher Nina D, Parola Rown, Bi Andrew S, Konda Sanjit R, Egol Kenneth A
NYU Langone Orthopedic Hospital, New York, NY, USA.
Jamaica Hospital Medical Center, Queens, NY, USA.
Hip Int. 2023 Jul;33(4):779-788. doi: 10.1177/11207000221107853. Epub 2022 Jun 30.
The purpose of this study was to investigate if early postoperative ambulation metrics affect hospital quality measures and 1-year outcomes in operative hip fracture patients.
A consecutive series of hip fracture patients [OTA/AO 31A, 31B, 32A-C] who underwent operative treatment were reviewed for demographic and clinical data. Chart review was performed to determine participation with physical therapy [PT] and ambulation distance on postoperative day (POD) 1, 3, and 5. POD1 ambulators and non-ambulators were statistically compared. Outcome correlates of postoperative ambulation distance were investigated by univariate and multivariate linear and logistic regression.
1044 patients were identified with 546 (52.3%) able to ambulate on POD1. Those able to ambulate on POD1 were significantly younger (78.4 ± 10.9 vs. 82.1 ± 10.4, 0.001), had fewer co-morbidities (CCI 1.22 ± 1.60 vs. 1.73 ± 1.82, 0.001), and were more likely to be preoperative community ambulators (82.2% vs. 68.3%, 0.001). Patients unable to ambulate on POD1 had significantly higher rate of inpatient mortality (2.8% vs. 0.5%, = 0.004), 1-year mortality (14.6% vs. 6.9%, 0.001), and a longer length of stay (7.94 ± 4.73 vs. 6.43 ± 4.02 days, 0.001). Non-ambulators more often required the intensive care unit postoperatively (18.7% vs. 7.1%, 0.001), and had increased rates of major complications (15.5% vs. 5.7%, 0.001). Patients with OTA 31B or 32A fractures were 1.63 times more likely to ambulate on POD1 while patients with an assistive device at baseline were 0.51 times less likely to ambulate on POD1. Increasing postoperative ambulation distance correlated with shorter length of stay ( 0.001 for POD1, 3, and 5) and every foot walked was associated with 0.57% decreased odds of a hospital complication ( = 0.0353).
Failure to ambulate on POD1 following hip fracture surgery in >55 years is associated with an increased risk of in-hospital complications and mortality. Every effort should be made address this modifiable risk factor and mobilise patients on POD1 to improve patient outcomes.
本研究旨在调查术后早期活动指标是否会影响手术治疗的髋部骨折患者的医院质量指标和1年预后。
对接受手术治疗的一系列连续髋部骨折患者[OTA/AO 31A、31B、32A - C]的人口统计学和临床数据进行回顾。通过病历审查确定术后第1天、第3天和第5天的物理治疗参与情况及活动距离。对术后第1天能活动和不能活动的患者进行统计学比较。通过单变量和多变量线性及逻辑回归研究术后活动距离的预后相关性。
共纳入1044例患者，其中546例（52.3%）在术后第1天能够活动。术后第1天能活动的患者明显更年轻（78.4±10.9岁 vs. 82.1±10.4岁，P<0.001），合并症更少（CCI 1.22±1.60 vs. 1.73±1.82，P<0.001），且术前更可能为社区活动者（82.2% vs. 68.3%，P<0.001）。术后第1天不能活动的患者住院死亡率显著更高（2.8% vs. 0.5%，P = 0.004），1年死亡率更高（14.6% vs. 6.9%，P<0.001），住院时间更长（7.94±4.73天 vs. 6.43±4.02天，P<0.001）。不能活动的患者术后更常需要入住重症监护病房（18.7% vs. 7.1%，P<0.001），主要并发症发生率更高（15.5% vs. 5.7%，P<0.001）。OTA 31B或32A骨折患者术后第1天活动的可能性是其他患者的1.63倍，而基线时使用辅助装置的患者术后第1天活动的可能性降低0.51倍。术后活动距离增加与住院时间缩短相关（术后第1天、第3天和第5天P<0.001），每多走1英尺，医院并发症发生几率降低0.57%（P = 0.0353）。
55岁以上髋部骨折手术后第1天不能活动与住院并发症和死亡率风险增加相关。应尽一切努力解决这一可改变的风险因素，并促使患者在术后第1天活动，以改善患者预后。
