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Time to Ambulation After Hip Fracture Surgery: Relation to Hospitalization Outcomes

¹ Division of Geriatrics and Gerontology, Medical College of Wisconsin, and GEM and Sub Acute Care Unit, Zablocki VAMC, Milwaukee, Wisconsin.
² Department of Medicine, Medical College of Wisconsin, Milwaukee.
³ Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri.
⁴ Division of Endocrinology and Metabolism, Medical College of Wisconsin and Zablocki VAMC, Milwaukee.
⁵ Health Policy Institute, Division of Biostatistics, Medical College of Wisconsin, Milwaukee.

Objective. To test the hypothesis: Time to ambulation (walking) after hip fracture surgery impacts the frequency of postoperative complications and length of hospital stay.

Methods. A retrospective observational study of a cohort of all patients admitted to a university teaching hospital with a principal International Classification of Diseases-9 diagnosis of a hip fracture during 3 calendar years.

Results. A total of 131 participants were identified (68% were aged 65 years or older). Overall, the mean time to writing an order to ambulate a patient after a hip fracture surgery was 2 ± 1.5 days. Time to ambulation after hip fracture surgery was significantly less in patients cared for on orthopedic surgery service compared to general surgery service (1.8 ± 1 vs 2.5 ± 2, p <.05) or general internal medicine service (2.5 ± 1.5, p <.05). It did not relate, however, to patient's age, sex, or race, or to patient's functional status prior to admission, fracture site (femoral neck, intertrochanteric, or subtrochanteric), whether a femoral neck fracture is displaced or not, type of anesthesia (spinal/epidural vs general), type of surgery (open reduction and internal fixation vs hemiarthroplasty), degree of preoperative risk, number of medical conditions, or to obtaining physical therapy and/or medical consultation. Time to ambulation after surgery was an independent predictor for the development of pneumonia (1.5 OR [odds ratio]/day, p <.001), new onset delirium (1.7 OR/day, p <.001), and to prolonged length of hospital stay (B [slope coefficient] = 1.36, p <.0001) but not to the development of pressure ulcers, deep venous thrombosis, or urinary tract infection.

Conclusions. Delayed ambulation after hip fracture surgery is related to the development of new onset delirium and pneumonia postoperatively as well as to increased length of hospital stay. Early ambulation after hip fracture surgery should be encouraged.