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Archives of Orthopaedic and Trauma Surgery

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01-11-2018 | Trauma Surgery

Timing of physiotherapy following fragility hip fracture: delays cost lives

Authors: Tal Frenkel Rutenberg, Maria Vitenberg, Barak Haviv, Steven Velkes

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2018

Abstract

Introduction

Post-operative physiotherapy (PT) following fragility hip fractures is intended to improve balance, gait, and muscle strength for enhanced functional outcomes. This study aims to assess whether postponing initiation of PT effects patients’ outcomes during hospitalization and in the first 3 months following discharge.

Materials and methods

A retrospective study comparing consecutive patients, 65 years and older, who were operated for fragility hip fractures between 2011 and 2016, within 48 h from admission, and started PT treatment either in the first post-operative day (POD1) or later (POD2-5). Patients were operated upon as soon as medically possible and in accordance with theater availability. All surgeries were performed outside of workday hours (either in the afternoon or during the weekend). Group allocation was established corresponding with the surgical day, as PT services are unavailable during weekends and holidays, and surgeries were performed daily. Primary outcomes were mortality either within hospital or in the post-operative year. Secondary outcomes were in-hospital complications, recurrent hospitalizations, and orthopedic complications within 3 months.

Results

747 patients were included in the study; 525 patients started PT at POD1 and 222 had delayed PT. Patients’ demographics, living arrangements, age-adjusted Charlsons’ co-morbidity index, mobility, hemoglobin levels, and implant type were comparable. In-hospital mortality was significantly higher for the delayed PT group, 6.8 vs. 3.2% (OR 2.2, 95% CI 1.06–4.42, p value 0.034). One-year mortality, in-hospital complications, and the average number of 3 months’ recurrent hospitalizations did not differ between groups. A trend for more orthopedic complications was noted in the delayed PT group (p = 0.099), and patients from this group were readmitted more often due to orthopedic surgery-related reasons (p = 0.031).

Conclusions

Post-operative delay in PT following fragility hip fracture surgery was related to increased risk for in-hospital mortality.

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Title: Timing of physiotherapy following fragility hip fracture: delays cost lives
Authors: Tal Frenkel Rutenberg
Maria Vitenberg
Barak Haviv
Steven Velkes
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 11/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-3010-1

At a glance: The STEP trials

Springer Medicine

Timing of physiotherapy following fragility hip fracture: delays cost lives

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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