Jenkins Ryne, Acampa Daniel, Hinnenkamp Glyn, Hoehmann Christopher L, Vaysman Maksim, Mon Nwe Oo, Ruotolo Charles, Murphy Dennis
Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY.
J Orthop Trauma. 2025 Apr 1;39(4):180-185. doi: 10.1097/BOT.0000000000002956.
To evaluate the effect of perioperative variables, including physical therapy (PT) and walking distance on length of stay (LOS) in hip fracture patients.
A retrospective review.
Single level I trauma center.
Patients aged 65 years and above with hip fractures Orthopaedic Trauma Association/AO Foundation 31-A and 31-B) between 2017 and 2020 were included. Patients were excluded if they were treated nonoperatively, suffered periprosthetic fracture, or were not admitted under the hip fracture protocol.
Admission and perioperative variables including time to surgery and number of postoperative days (PODs) without a documented PT session during the first 3 PODs were assessed for correlation with increased total hospital LOS and postoperative LOS.
There were 301 patients included [234 (77.7%) female] with an average age of 84.4 years (±8.1 years). The median total LOS was 5 (interquartile range, 3-7) days and 4 (interquartile range 3-6) days after surgical fixation. Thirty-seven percentage of hip fractures had a delay in discharge. Ninety-five percentage of patients were discharged to a rehabilitation facility. The highest percentage of days with no PT session occurred on Saturdays and Sundays with 43% and 34% on POD 1, respectively; 40% and 33% on POD 2; and 26% and 30% on POD 3; P = 0.0004. In multivariate analysis, longer total LOS was associated with time to surgery more than 24 hours [AOR 5.6; 95% confidence interval (CI), 1.8-17.4; P < 0.0030], major complication (AOR 8.26; 95% CI, 2.8-20.0; P < 0.0014), discharge to subacute rehab (AOR 5.6; 95% CI, 3.0-10.5; P < 0.0001), and walking < 5 feet or not receiving PT (among patients with no assistance required as prehospital ambulatory status) (AOR 6.0; 95% CI, 2.3-15.3; P < 0.02). Longer LOS after surgery was associated with major complication (AOR 11.2; 95% CI, 3.1-39.8; P < 0.0002), discharge to subacute rehab (AOR 5.0; 95% CI, 2.7-9.1; P < 0.0001), and walking < 5 feet or no PT (AOR 4.8; 95% CI, 2.0-11.5; P < 0.01).
Emphasis should be placed on minimizing complications while maximizing postoperative PT and early ambulation in the acute postoperative period, given the demonstrated association between inadequate mobilization and delayed disposition, especially if surgical fixation occurs surrounding the weekend or holiday.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估围手术期变量，包括物理治疗（PT）和行走距离对髋部骨折患者住院时间（LOS）的影响。
回顾性研究。
单一的I级创伤中心。
纳入2017年至2020年间年龄在65岁及以上、患有髋部骨折（骨科创伤协会/AO基金会31 - A和31 - B型）的患者。若患者接受非手术治疗、发生假体周围骨折或未按照髋部骨折治疗方案收治，则予以排除。
评估入院和围手术期变量，包括手术时间以及术后前3天无PT记录的术后天数（PODs），以确定其与总住院LOS增加及术后LOS增加之间的相关性。
共纳入301例患者[234例（77.7%）为女性]，平均年龄84.4岁（±8.1岁）。手术固定后，总LOS中位数为5天（四分位间距，3 - 7天），术后LOS中位数为4天（四分位间距3 - 6天）。37%的髋部骨折患者出院延迟。95%的患者出院后前往康复机构。无PT治疗的天数比例最高出现在周六和周日，术后第1天分别为43%和34%；术后第2天分别为40%和33%；术后第3天分别为26%和30%；P = 0.0004。多因素分析显示，总LOS延长与手术时间超过24小时相关[AOR 5.6；95%置信区间（CI），1.8 - 17.4；P < 0.0030]、发生主要并发症（AOR 8.26；95% CI，2.8 - 20.0；P < 0.0014）、出院后前往亚急性康复机构（AOR 5.6；95% CI，3.0 - 10.5；P < 0.0001）以及行走距离<5英尺或未接受PT治疗（对于院前可独立行走的患者）（AOR 6.0；95% CI，2.3 - 15.3；P < 0.02）。术后LOS延长与主要并发症相关（AOR 11.2；95% CI，3.1 - 39.8；P < 0.0002）、出院后前往亚急性康复机构（AOR 5.0；95% CI，2.7 - 9.1；P < 0.0001）以及行走距离<5英尺或未接受PT治疗（AOR 4.8；95% CI，2.0 - 11.5；P < 0.01）。
鉴于已证实活动不足与出院延迟之间的关联，尤其是在周末或节假日前后进行手术固定时，应着重在术后急性期尽量减少并发症，同时最大化术后PT治疗及早期活动。
预后III级。有关证据级别的完整描述，请参阅作者指南。
