Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Horton, Bourget-Murray, Buth, Green, Papp, Grammatopoulos); Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Bourget-Murray, Backman, Papp, Grammatopoulos).
Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Horton, Bourget-Murray, Buth, Green, Papp, Grammatopoulos); Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Bourget-Murray, Backman, Papp, Grammatopoulos)
Can J Surg. 2023 Aug 29;66(4):E432-E438. doi: 10.1503/cjs.006822. Print 2023 Jul-Aug.
Current national guidelines on caring for hip fractures recommend early mobilization. However, this recommendation does not account for time spent immobilized waiting for surgery. We sought to determine timing of mobilization following hip fracture, beginning at hospital admission, and evaluate its association with medical complications and length of hospital stay (LOS).
We performed a retrospective review of prospectively collected data for 470 consecutive patients who underwent surgery for a hip fracture between September 2019 and August 2020 at an academic, tertiary-referral hospital. Outcomes of interest included time from hospital admission to mobilization, complication rate and LOS. We used a binary regression analysis to determine the effect of different surgical and patient factors on the risk of a postoperative medical complication.
The mean time from admission to mobilization was 2.8 ± 2.3 days (range 3 h-14 d). There were 125 (26.6%) patients who experienced at least 1 complication. The odds of developing a complication began to increase steadily once a patient waited more than 3 days from admission to mobilization (odds ratio 2.15, 95% confidence interval 1.42-3.25). Multivariate regression analysis showed that prefracture frailty (β = 0.276, = 0.05), and timing from hospital admission to mobilization (β = 0.156, < 0.001) and from surgery to mobilization (β = 1.195, < 0.001) were associated with complications. The mean LOS was 12.2 ± 10.7 days (range 1-90 d). Prolonged wait to mobilization was associated with longer LOS ( = 0.01).
Comprehensive guidelines on timing of mobilization following hip fracture should account for cumulative time spent immobilized.
目前关于髋部骨折护理的国家指南建议早期活动。然而，这一建议并没有考虑到因等待手术而不得不固定不动的时间。我们旨在确定从入院开始进行髋部骨折后活动的时机，并评估其与医疗并发症和住院时间（LOS）的关系。
我们对 2019 年 9 月至 2020 年 8 月在一所学术性三级转诊医院接受髋关节骨折手术的 470 例连续患者前瞻性收集的数据进行了回顾性分析。感兴趣的结果包括从入院到活动的时间、并发症发生率和 LOS。我们使用二元回归分析来确定不同手术和患者因素对术后医疗并发症风险的影响。
从入院到活动的平均时间为 2.8 ± 2.3 天（范围 3 小时-14 天）。有 125 例（26.6%）患者至少发生了 1 种并发症。一旦患者从入院到活动的等待时间超过 3 天，发生并发症的几率就会稳步增加（优势比 2.15，95%置信区间 1.42-3.25）。多变量回归分析显示，骨折前虚弱（β=0.276，P=0.05）以及从入院到活动的时间（β=0.156，P<0.001）和从手术到活动的时间（β=1.195，P<0.001）与并发症相关。平均 LOS 为 12.2 ± 10.7 天（范围 1-90 天）。活动推迟与 LOS 延长相关（P=0.01）。
髋部骨折后活动时机的综合指南应考虑到固定不动的累计时间。
