The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery.

Autor:	Kristensen MT; Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg-Frederiksberg, University of Copenhagen, Copenhagen, Denmark.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark., Turabi R; Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK.; Department of Physical Therapy, Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia., Sheehan KJ; Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK.; Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
Jazyk:	angličtina
Zdroj:	Clinical rehabilitation [Clin Rehabil] 2024 Jul; Vol. 38 (7), pp. 990-997. Date of Electronic Publication: 2024 Feb 12.
DOI:	10.1177/02692155241231225
Abstrakt:	Objective: To determine the association between the extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture. Design: Cohort study. Setting: Acute orthopaedic hospital ward. Participants: Consecutive sample of 701 patients, 65 years of age or older, 80% from own home, 49% with a trochanteric fracture, and 61% with an American Society of Anesthesiology grade > 2. Intervention: n/a . Main Measures: Cumulated ambulation score (CAS) (0-6 points) on the first postoperative day and 30-day postoperative mortality. A CAS = 0 reflects no functional mobility (bedridden), while a CAS = 6 reflects independent out-of-bed-transfer, chair-stand, and indoor walking status. Results: Overall, 86% of patients were mobilised to standing or seated in chair (CAS ≥ 1) on the first postoperative day. A CAS of 0, 1-3, and 4-6 was observed for 97 (14%), 519 (74%), and 85 (12%) patients, respectively. Overall, 61 (8.7%) patients died within 30 days with the highest mortality (23.7%, n = 23) seen for those not mobilised (CAS = 0). Only one patient (1.2%) with a CAS of 4-6 points died. Cox regression analysis adjusted for age, sex, residential status, pre-fracture CAS, fracture type, and American Society of Anesthesiology grade, showed that a one-unit increase in CAS was associated with a 38% lower risk of 30-day mortality (Hazard Ratio = 0.63, 95%Confidence Interval, 0.50-0.78). Conclusion: Mobility on the first postoperative day was associated with 30-day postoperative mortality, with a lower risk observed for those completing greater mobility. National registries may consider extending collection of mobility on the first postoperative day from a binary indicator to the CAS which captures the extent of mobility achieved. Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Katie Sheehan receives funding from UK Research & Innovation, the National Institutes of Health Research and Chartered Society of Physiotherapy Charitable Trust for hip fracture health services research not related to the current manuscript. Katie Sheehan is the Chair of the Scientific and Publications Committee of the Falls and Fragility Fracture Audit Programme which manages the National Hip Fracture Database audit at the Royal College of Physicians. Morten Tange Kristensen is a co-inventor and responsible for the CAS but did not participate in data collection for the study, and otherwise declares no conflict of interest. Ruqayyah Turabi declares no conflict of interest.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu