scholarly journals Get up and get moving—early mobilisation after hip fracture surgery

2020 ◽  
Author(s):  
Hakimah Sallehuddin ◽  
Terence Ong
Keyword(s):  
Hip Fracture ◽  
Early Mobilisation ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals 34 Discharge After Hip Fracture Surgery by Mobilisation Timing: Secondary Analysis of the UK National Hip Fracture Database

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i7-i11
Author(s):  
A Goubar ◽  
O Almilaji ◽  
F C Martin ◽  
C Potter ◽  
G D Jones ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Average Rate ◽  
Small Sample Size ◽  
Small Sample ◽  
Competing Risk ◽  
Hospital Death ◽  
Early Mobilisation ◽  
Hip Fracture Surgery ◽  
Risk Of Death ◽  
Fracture Surgery

Abstract Background To maximise the benefits of hip fracture surgery the National Institute for Health and Care Excellence Clinical Guideline recommends mobilisation on the day after hip fracture surgery based a low to moderate quality trial with a small sample size. There is a need to generate additional evidence to support early mobilisation as a new UK Best Practice Tariff (BPT). Objective To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30-days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death. Method We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between January 2014 and December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 hours of surgery) and those mobilised late accounting for potential confounders and the competing risk of in-hospital death. Results 106,722 (79%) of patients first mobilised early. The average rate of discharge was 60.1 (95% CI 59.8–60.5) per 1,000 patient days, varying from 65.2 (95% CI 64.8–65.6) among those who mobilised early to 44.5 (95% CI 43.9–45.1) among those who mobilised late, accounting for the competing risk of death. By 30-days postoperatively, the crude and adjusted odds ratios of discharge were 2.26 (95% CI 2.2–2.32) and 1.93 (95% CI 1.86–1.99) respectively among those who first mobilised early compared to those who mobilised late, accounting for the competing risk of death. Conclusion Early mobilisation led to a near two fold increase in the adjusted odds of discharge by 30-days postoperatively. We recommend inclusion of mobilisation within 36 hours of surgery as a new UK BPT to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.

scholarly journals Early mobilisation following fragility hip fracture surgery: current trends and association with dicharge outcomes in a local tertiary hospital

2021 ◽  
Author(s):  
S Tan ◽  
A Vasireddy
Keyword(s):  
Hip Fracture ◽  
Functional Recovery ◽  
Early Mobilisation ◽  
Local Study ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Current Trends ◽  
Significant Difference ◽  
Fracture Surgery ◽  
Early Functional Recovery

Introduction: Postoperative day 1 (POD1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD1 mobilisation at our institution; and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination. Methods: In this preliminary observational study, data pertaining to demographics, pre-morbid function, health status, injury and surgical factors, POD1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD1 ambulation formed the “Early Ambulation (EA)” Group while the remaining patients formed the “Delayed Ambulation (DA)” group. Data were analysed for any significant difference between the groups. Results: 115 patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD1 was 80.0% (92 patients) which was comparable with data available from international hip fracture audit databases. 55 patients (47.8%) formed the EA group and 60 patients (52.5%) formed the DA group. EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20; 95% Confidence Interval 1.50-56.45; p = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to DA group (p > 0.05). Conclusion: This is the first local study to offer benchmark of the POD1 mobilisation status for this population. Patients who attained POD1 ambulation had better early functional recovery.

scholarly journals A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

2021 ◽  
Author(s):  
Rebecka Ahl ◽  
Ahmad Mohammad Ismail ◽  
Tomas Borg ◽  
Gabriel Sjölin ◽  
Maximilian Peter Forssten ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Beta Blocker ◽  
Observational Cohort Study ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Hip Fracture Surgery ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
Fracture Surgery

Abstract Purpose Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery. Methods This is a retrospective nationwide observational cohort study. All adults $$\ge$$ ≥ 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality. Results 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26–0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure. Conclusions Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

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