Timing of physiotherapy following fragility hip fracture: delays cost lives

Abstract

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 3months following discharge. A retrospective study comparing consecutive patients, 65years and older, who were operated for fragility hip fractures between 2011 and 2016, within 48h 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 3months. 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 3months' 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). Post-operative delay in PT following fragility hip fracture surgery was related to increased risk for in-hospital mortality.