Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Injury. 2022 Dec;53(12):4086-4089. doi: 10.1016/j.injury.2022.09.040. Epub 2022 Sep 25.
While the importance of timely surgery and early mobilization are understood in geriatric fracture populations, the relationship between timing of initiation of physical therapy (PT) postoperatively on length of stay (LOS) and mortality has not been well delineated. The purpose of this investigation was to determine the effect of PT initiated on postoperative day zero (POD0) on LOS and mortality in geriatric hip fracture patients.
Patients aged 60 and over who underwent hip fracture surgery, including arthroplasty or internal fixation, between January 2017 and December 2019 at three affiliated academic hospitals were identified. Retrospective chart review and review of hospital charges were used to determine patient demographics, Charlson Comorbidity Index (CCI), surgery performed, timing of postoperative PT visits, LOS, and mortality.
Of 1,551 patients identified that met inclusion criteria, 83 (5.3%) received PT on POD0. Most patients (76.3%) received PT on postoperative day 1 (POD1), and 18.4% received first PT on postoperative day 2 or later (POD2+). Time from admission to surgery, CCI, sex, and BMI did not differ significantly between groups. The age difference between patients in the POD0 and the POD1/POD2+ groups was statistically significant with the mean age in the POD1/2+ group being 2.3 years older than the POD0 group (p=0.045). There was no difference in postoperative length of stay (PLOS) based on type of fixation. The average PLOS was 3.4 days in the POD0 PT group compared to 5.2 days in the POD1 group (p<0.0001) and 8.2 days in the POD2+ group (p<0.0001). The POD0/1 group had significantly lower mortality than the POD2+ group [3.7% vs. 9.8%, OR 0.354 (95% CI 0.217-0.575), p<0.0001].
Earlier initiation of PT postoperatively is associated with significantly shorter total and postoperative LOS and initiation of PT before POD2 is associated with decreased 30-day mortality. Each day that initiation of PT is delayed is associated with a two- to three-day increase in LOS.
尽管老年人骨折患者已经了解到及时手术和早期活动的重要性，但术后开始物理治疗（PT）的时间与住院时间（LOS）和死亡率之间的关系尚未明确。本研究旨在确定术后第 0 天（POD0）开始 PT 对老年髋部骨折患者 LOS 和死亡率的影响。
本研究回顾性分析了 2017 年 1 月至 2019 年 12 月在 3 家附属医院接受髋部骨折手术（包括关节置换或内固定术）的年龄在 60 岁及以上的患者。通过病历回顾和医院费用审查，确定患者的人口统计学特征、Charlson 合并症指数（CCI）、手术类型、术后 PT 就诊时间、LOS 和死亡率。
在符合纳入标准的 1551 名患者中，有 83 名（5.3%）在 POD0 接受了 PT。大多数患者（76.3%）在术后第 1 天（POD1）接受 PT，18.4%在术后第 2 天或更晚（POD2+）开始首次 PT。入院至手术时间、CCI、性别和 BMI 在组间无显著差异。POD0 组和 POD1/POD2+组之间的患者年龄差异具有统计学意义，POD1/2+组的平均年龄比 POD0 组大 2.3 岁（p=0.045）。固定方式不同，术后 LOS 无差异。POD0 PT 组的平均 LOS 为 3.4 天，POD1 组为 5.2 天（p<0.0001），POD2+组为 8.2 天（p<0.0001）。POD0/1 组的死亡率明显低于 POD2+组[3.7%比 9.8%，OR 0.354（95%CI 0.217-0.575），p<0.0001]。
术后尽早开始 PT 与 LOS 和术后 LOS 显著缩短相关，POD2 之前开始 PT 与 30 天死亡率降低相关。PT 开始时间每延迟一天，LOS 就会增加两到三天。
