Richard J VanTienderen1, Isaac Fernandez, Michael S Reich, Mai P Nguyen. 1. From the Department of Orthopedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX (Dr. VanTienderen and Dr. Fernandez), the Department of Orthopedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX (Dr. VanTienderen and Dr. Fernandez), the Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN (Dr. Reich), and the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Nguyen).
Abstract
INTRODUCTION: Hip fractures in the elderly are associated with notable morbidity. The influence of postoperative ambulation on outcomes is not well described. We hypothesized that patients who mobilize faster after surgical intervention would demonstrate fewer postoperative complications. METHODS: A retrospective review was performed on patients with hip fractures from October 2015 through September 2017. All ambulatory patients at least 65 years old (y/o), with a low-energy mechanism of injury, and who underwent surgical treatment were included. Physical therapy notes were used to track postoperative ambulation, and medical records were reviewed for 90-day postoperative complications. RESULTS: One hundred sixty-three patients were included (64 femoral neck, 88 intertrochanteric, and 11 subtrochanteric fractures). Eighty patients had postoperative complication(s). Walking >5 feet by 72 hours postoperatively was associated with decreased morbidity (complication rate: 31% versus 77% (≤5 feet ambulation), P < 0.001). Walking >5 feet by 72 hours postoperatively decreased the likelihood of myocardial infarction (P = 0.003), pneumonia (P = 0.021), intensive care unit admission (P < 0.001), and death or hospice transfer (P < 0.001). DISCUSSION: Ambulating >5 feet within 72 hours postoperatively is associated with a lower postoperative complication rate. To our knowledge, this study is the first to quantify the relationship between postoperative hip fracture mobilization and morbidity and mortality. LEVEL OF EVIDENCE: Prognostic, Level III.
INTRODUCTION:Hip fractures in the elderly are associated with notable morbidity. The influence of postoperative ambulation on outcomes is not well described. We hypothesized that patients who mobilize faster after surgical intervention would demonstrate fewer postoperative complications. METHODS: A retrospective review was performed on patients with hip fractures from October 2015 through September 2017. All ambulatory patients at least 65 years old (y/o), with a low-energy mechanism of injury, and who underwent surgical treatment were included. Physical therapy notes were used to track postoperative ambulation, and medical records were reviewed for 90-day postoperative complications. RESULTS: One hundred sixty-three patients were included (64 femoral neck, 88 intertrochanteric, and 11 subtrochanteric fractures). Eighty patients had postoperative complication(s). Walking >5 feet by 72 hours postoperatively was associated with decreased morbidity (complication rate: 31% versus 77% (≤5 feet ambulation), P < 0.001). Walking >5 feet by 72 hours postoperatively decreased the likelihood of myocardial infarction (P = 0.003), pneumonia (P = 0.021), intensive care unit admission (P < 0.001), and death or hospice transfer (P < 0.001). DISCUSSION: Ambulating >5 feet within 72 hours postoperatively is associated with a lower postoperative complication rate. To our knowledge, this study is the first to quantify the relationship between postoperative hip fracture mobilization and morbidity and mortality. LEVEL OF EVIDENCE: Prognostic, Level III.
Authors: Richard J VanTienderen; Kyle Bockelman; Rami Khalifa; Michael S Reich; Adam Adler; Mai P Nguyen Journal: Geriatr Orthop Surg Rehabil Date: 2021-03-25