Mazarello Paes Veena, Ting Andrew, Masters James, Paes Mahalia V I, Graham Simon Mathew, Costa Matthew L
Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Kingston Hospital NHS Foundation Trust, London, UK.
Bone Jt Open. 2025 Jul 3;6(7):741-747. doi: 10.1302/2633-1462.67.BJO-2024-0243.R1.
Performance indicators are increasingly used to evaluate the quality of healthcare provided to patients following a hip fracture. In this systematic review, we investigated the association between 'early mobilization' after surgery and patient outcomes.
Evidence was searched through 12 electronic databases and other sources. The methodological quality of studies meeting the inclusion criteria was assessed. The protocol for this suite of related systematic reviews was registered at PROSPERO: ID = CRD42023417515.
A total of 24,507 articles were reviewed, and 20 studies met the inclusion criteria for the review, involving a total of 317,173 patients aged over 60 years with a hip fracture. There were two randomized clinical trials, five prospective studies, and 13 retrospective cohort studies, conducted between January 1981 and June 2022. All but two studies came from high-income healthcare systems. The definition of early mobilization varied across studies and health systems; and weightbearing status was often not reported or ambiguously defined, making formal meta-analysis of the data impossible. Early mobilization (within 48 hours of surgery) was associated with improved outcomes in 29 of the 33 patient-reported outcomes, including improved mobility scores and improved assessments of daily activities of living. A total of 45 out of 51 clinical outcomes derived from hospital records showed a positive association with early mobilization, including reduced rates of postoperative complications, reduced length of acute hospital stay, and lower mortality.
Early mobilization after surgery for hip fracture in older people is associated with improved patient-reported outcomes and reduced length of hospital stay. Standardization of the definition of early mobilization and consistent reporting of weightbearing status would improve future evidence synthesis.
绩效指标越来越多地用于评估髋部骨折患者接受的医疗服务质量。在本系统评价中，我们研究了手术后“早期活动”与患者预后之间的关联。
通过12个电子数据库和其他来源检索证据。对符合纳入标准的研究的方法学质量进行评估。这一系列相关系统评价的方案已在国际前瞻性系统评价注册库（PROSPERO）注册：标识符=CRD42023417515。
共检索了24507篇文章，20项研究符合该评价的纳入标准，涉及317173例60岁以上髋部骨折患者。有两项随机临床试验、五项前瞻性研究和十三项回顾性队列研究，时间跨度为1981年1月至2022年6月。除两项研究外，所有研究均来自高收入医疗体系。不同研究和医疗体系对早期活动的定义各不相同；负重状态往往未报告或定义模糊，因此无法对数据进行正式的荟萃分析。在33项患者报告的结局中，有29项结局显示早期活动（术后48小时内）与预后改善相关，包括活动能力评分提高和日常生活活动评估改善。医院记录得出的51项临床结局中有45项与早期活动呈正相关，包括术后并发症发生率降低、急性住院时间缩短和死亡率降低。
老年人髋部骨折手术后早期活动与患者报告的预后改善及住院时间缩短相关。早期活动定义的标准化和负重状态的一致报告将改善未来的证据综合。
