280 Does Delayed Physiotherapy Assessment Postoperatively Affect Mortality or Length of Stay in Patients Following Surgery for a Neck of Femur Fracture?

Abstract

Abstract Aim National guidance states that patients with a neck of femur fracture (NOFF) should be assessed by a physiotherapist on the first postoperative day. This can pose problems given the finite availability of physiotherapists. This study aims to determine if delayed assessment impacts patients' postoperative mortality or length of stay in the hospital. Method A prospective case series of all NOFFs surgically treated at a major trauma centre between 2013-2022 was performed. Patients ≥65 years of age were included from a unit-based prospective database. Results A total of 3411 patients were included. 3062 were assessed by a physiotherapist on the first postoperative day (POD1), and 349 on day two and beyond (POD2+). Delayed physiotherapy was principally due to the day of operation, where the POD2+ group more likely had surgery on a Friday or Saturday, p<0.001. The two groups were comparable in age, gender, fracture morphology, preoperative ASA and Rockwood frailty scores, and surgical procedure. The average length of stay for POD1 was 16.9 days (SD = 21.1), and 16.0 days (SD = 12.4) for POD2+, p = 0.450. Mortality was lower in the POD2+ group at 30 days after surgery, p = 0.040. There was no difference in mortality at 1 year, p = 0.295, 2 years, p = 0.724, and overall, p = 0.826. Conclusions Delayed physiotherapy assessment does not worsen length of stay in NOFF patients. Lower early mortality in this group indicates a possible benefit in delaying physiotherapy assessment although there was no significant difference in mortality beyond 30 days. However, a seven-day physiotherapy service would still be required for continuity of postoperative care.