Abstract
Introduction
Post-operative physiotherapy (PT) following fragility hip fractures is intended to improve balance, gait, and muscle strength for enhanced functional outcomes. This study aims to assess whether postponing initiation of PT effects patients’ outcomes during hospitalization and in the first 3 months following discharge.
Materials and methods
A retrospective study comparing consecutive patients, 65 years and older, who were operated for fragility hip fractures between 2011 and 2016, within 48 h from admission, and started PT treatment either in the first post-operative day (POD1) or later (POD2-5). Patients were operated upon as soon as medically possible and in accordance with theater availability. All surgeries were performed outside of workday hours (either in the afternoon or during the weekend). Group allocation was established corresponding with the surgical day, as PT services are unavailable during weekends and holidays, and surgeries were performed daily. Primary outcomes were mortality either within hospital or in the post-operative year. Secondary outcomes were in-hospital complications, recurrent hospitalizations, and orthopedic complications within 3 months.
Results
747 patients were included in the study; 525 patients started PT at POD1 and 222 had delayed PT. Patients’ demographics, living arrangements, age-adjusted Charlsons’ co-morbidity index, mobility, hemoglobin levels, and implant type were comparable. In-hospital mortality was significantly higher for the delayed PT group, 6.8 vs. 3.2% (OR 2.2, 95% CI 1.06–4.42, p value 0.034). One-year mortality, in-hospital complications, and the average number of 3 months’ recurrent hospitalizations did not differ between groups. A trend for more orthopedic complications was noted in the delayed PT group (p = 0.099), and patients from this group were readmitted more often due to orthopedic surgery-related reasons (p = 0.031).
Conclusions
Post-operative delay in PT following fragility hip fracture surgery was related to increased risk for in-hospital mortality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ryan DJ, Yoshihara H, Yoneoka D et al (2015) Delay in hip fracture surgery: an analysis of patient-specific and hospital-specific risk factors. J Orthop Trauma 29:343–348. https://doi.org/10.1097/BOT.0000000000000313
Magaziner J, Chiles N, Orwig D (2015) Recovery after hip fracture: interventions and their timing to address deficits and desired outcomes—evidence from the Baltimore hip studies. Nestle Nutr Inst Workshop Ser 83:71–81
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413
Rosso F, Dettoni F, Edoardo D et al (2017) Prognostic factors for mortality after hip fracture: operation within 48 hours is mandatory. Injury 47:S91–S97. https://doi.org/10.1016/j.injury.2016.07.055
Anthony CA, Duchman KR, Bedard NA et al (2017) Hip fractures: appropriate timing to operative intervention. J Arthroplasty 32:3314–3318. https://doi.org/10.1016/j.arth.2017.07.023
Al-Ani AN, Samuelsson B, Tidermark J et al (2008) Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am 90:1436–1442. https://doi.org/10.2106/JBJS.G.00890
Khan SK, Kalra S, Khanna A et al (2009) Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury 40:692–697. https://doi.org/10.1016/j.injury.2009.01.010
Leung F, Lau TW, Kwan K et al (2010) Does timing of surgery matter in fragility hip fractures? Osteoporos Int 21:S529–S534. https://doi.org/10.1007/s00198-010-1391-2
Shiga T, Wajima Z, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 55:146–154. https://doi.org/10.1007/BF03016088
Siu AL, Penrod JD, Boockvar KS et al (2006) Early ambulation after hip fracture: effects on function and mortality. Arch Intern Med 166:766–771. https://doi.org/10.1001/archinte.166.7.766
Kamel HK, Iqbal MA, Mogallapu R et al (2003) Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. J Gerontol A Biol Sci Med Sci 58:1042–1045
Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251
Creditor MC (1993) Hazards of hospitalization of the elderly. Ann Intern Med 118:219–223
Kronborg L, Bandholm T, Palm H et al (2016) Physical activity in the acute ward following hip fracture surgery is associated with less fear of falling. J Aging Phys Act 24:525–532. https://doi.org/10.1123/japa.2015-0071
Jette AM, Harris BA, Cleary PD, Campion EW (1987) Functional recovery after hip fracture. Arch Phys Med Rehabil 68:735–740
Chan YM, Tang N, Chow SK (2017) Surgical outcome of daytime and out-of-hours surgery for elderly patients with hip fracture. Hong Kong Med J. https://doi.org/10.12809/hkmj165044
Nijland LMG, Karres J, Simons AE et al (2017) The weekend effect for hip fracture surgery. Injury 48:1536–1541. https://doi.org/10.1016/j.injury.2017.05.017
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The study was approved by the institution review board. This article does not contain any studies with animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Frenkel Rutenberg, T., Vitenberg, M., Haviv, B. et al. Timing of physiotherapy following fragility hip fracture: delays cost lives. Arch Orthop Trauma Surg 138, 1519–1524 (2018). https://doi.org/10.1007/s00402-018-3010-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-018-3010-1