Early mobilization after hip fracture surgery tied to better functional recovery

Patients achieving early mobilization following a fragility hip fracture procedure demonstrate faster functional recovery, suggests a Singapore study.

“[T]his is the first local study to offer a benchmark of postoperative day 1 (POD 1) mobilization status for the fragility hip fracture population,” the researchers said. “It highlights that patients who attained POD 1 ambulation had better early functional recovery.”

The study obtained data regarding demographics, premorbid function, health status, injury and surgical factors, POD 1 mobilization status, and clinical outcomes of interest from 115 eligible patients. Patients who attained POD 1 ambulation comprised the early ambulation (EA) group, while the rest formed the delayed ambulation (DA) group.

The researchers then analysed the collected data for any significant difference between the two groups. [Singapore Med J 2023;64:721-727]

Of the patients, 92 (80.0 percent) achieved at least sitting out of bed on POD 1. This was similar to the data available from international hip fracture audit databases. Fifty-five patients (47.8 percent) formed the EA group and 60 (52.5 percent) the DA group.

The EA group had nearly ninefold chance of attaining independence in ambulation at discharge relative to the DA group (adjusted odds ratio, 9.20, 95 percent confidence interval, 1.50‒56.45; p=0.016). Likewise, patients in the EA group had shorter length of stay (LOS) and were more likely to be home discharged compared to those in the DA group (p>0.05).

“For measures of LOS and discharge destination, there were similar trends in favour of patients who achieved ambulation on POD 1,” the researchers said. “However, these observed trends did not reach statistical significance.”

Early mobilization

Previous studies also reported similar trends supporting the EA group, with varying levels of statistical significance. [ANZ J Surg 2006;76:607-611; Arch Phys Med Rehabil 2009;90:1495-1498; BMC Musculoskelet Disord 2018;19:211; SICOT J 2019;5:4]

“There are a few possible explanations for why the observed trends in this study did not achieve statistical significance,” the researchers said. “Firstly, LOS and discharge destinations are influenced by other factors.”

In one study, longer LOS for acute hospitalization among the hip fracture population correlated with male gender, higher American Society of Anesthesiologists score, preoperative cardiac testing, and admission day of the week between Thursday and Friday. [J Orthop Trauma 2015;29:e109-114]

Another study found social issues pertaining to caregiving to be a key factor that influenced discharge planning for the geriatric population in the local setting. [Ann Acad Med Singap 2006;35:27-32]

“Almost all of the fragility hip fracture cohort patients do not return to their baseline at the point of discharge from acute care. Thus, the influence of caregiving issues on discharge planning is likely present in the fragility hip fracture cohort at this timeframe,” the researchers said.

“Early mobilization is an integral milestone in the postoperative recovery of fragility hip fracture surgery patients, and it is recommended in all the international clinical guidelines for this population,” they noted. [https://www.nice.org.uk/guidance/cg124; https://pdf4pro.com/cdn/part-of-nhs-quality-improvement-scotland-2531e4.pdf; https://anzhfr.org/wp-content/uploads/2016/07/ANZ-Guideline-for-Hip-Fracture-Care.pdf]