Abstract
Introduction: Early recovery of mobilization after a fracture of the hip is associated with improved long-term ability to walk, lower complication rates, and mortality. In this context, early mobilization and full weight bearing are favorable. The aim of this study was (1) to analyze the influence of time between operation and first mobilization on in-hospital outcome and (2) the influence of early mobilization, full weight bearing, and ASA on pain, mobility of the hip, and ability to walk during the in-hospital phase of recovery.Methods: This is a retrospective in-hospital study of 219 patients aged 70 years or older who were treated with surgery after a hip fracture. Data were collected by a review of medical records. The outcomes were mortality, complications, length of stay, and the Merle d’Aubigné score which evaluates pain, mobility of the hip, and ability to walk. Factors were sought in bivariate and multivariate analyses.Results: A shorter time between operation and first mobilization was significantly associated with lower in-hospital mortality and complications. Early mobilization (within 24 h after the operation) and full weight bearing had no influence on pain, mobility of the hip, and ability to walk as well as length of stay in our cohort. Fracture type and treatment influenced mobility of the hip, while age as well as physical health status affected the ability to walk.Discussion: Patients with femoral neck fractures, respectively after total hip arthroplasty, had less pain and showed better mobility of the hip and ability to walk during hospitalization than patients with trochanteric fractures; these results were irrespective of early vs. late mobilization and full vs. partial weight bearing. Foremost, a shorter time between operation and first mobilization is associated with lower complication and mortality rates.
Highlights
The increase in life expectancy in the past few decades has led to a substantial increase in fragility fractures
Anesthesiologist Physical Status classification (ASA) as well as time between operation and first mobilization were associated with mortality (p = 0.001 and p < 0.001)
ASA, and time between operation and first mobilization were associated with in-hospital complications (p = 0.033, p < 0.001, and p = 0.023)
Summary
The increase in life expectancy in the past few decades has led to a substantial increase in fragility fractures. Hip fractures are common and serious injuries of elderly people that lead to loss of mobility and independency and result in significant socioeconomic consequences [1,2]. Patients with hip fractures often present with comorbidities and frequently suffer complications during their hospital stay [3]. The main goals of the treatment of hip fractures are early mobilization and return to previous social activities, many patients never recover to their prefracture functional level [4,5]. Recovery of mobilization has a significant impact on short-term results, such as lower complication rates and shorter length of stay, and results in better long-term outcomes such as higher autonomy and reduced mortality [6,7,8,9,10,11]
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