Early Mobilization and Predictors of Delayed Disposition for Geriatric Hip Fractures

Objectives: To evaluate the effect of perioperative variables including PT and walking distance on length of stay (LOS) in hip fracture patients.

Methods: Design: A retrospective review.

Setting: Single level I trauma center.

Patient selection criteria: Patients ≥ 65 years of age with hip fractures (OTA/AO 31-A and 31-B) between 2017-2020 were included. Patients were excluded if they were treated nonoperatively, suffered periprosthetic fracture or were not admitted under the hip fracture protocol.

Outcome measures and comparisons: Admission and perioperative variables including time to surgery and number of postoperative days (PODs) without a documented PT session during the first three PODs were assessed for correlation with increased total hospital length of stay and postoperative length of stay.

Results: There were 301 patients included (234 (77.7%) female) with an average age of 84.4 years (± 8.1 years). Median total LOS was 5 [IQR, 3-7] days and 4 [IQR 3-6] days after surgical fixation. 37% of hip fractures had a delay in discharge. 95% 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% POD#3; p = 0.0004. In multivariate analysis longer total LOS was associated with time to surgery greater than 24 hours (AOR 5.6; 95% 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 less than five feet or not receiving PT (among patients with no assistance required as pre-hospital 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 less than five feet or no PT (AOR 4.8; 95% CI, 2.0-11.5; p<0.01).

Conclusions: 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.

Level of evidence: Level III.