The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery
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Published on: September 7, 2022
Morten Tange Kristensen1,2,3, Ruqayyah Turabi4,5, Katie J Sheehan4,6
1Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg-Frederiksberg, University of Copenhagen, Copenhagen, Denmark.
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.
