Discharge after hip fracture surgery in relation to mobilisation timing by patient characteristics: linked secondary analysis of the UK National Hip Fracture Database

BMC Geriatrics

Katie J. Sheehan¹  Aicha Goubar¹  Salma Ayis¹  Catherine Sackley¹  Finbarr C. Martin²  Chris Potter³  Gareth D. Jones³ 

[1] Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, 2nd Floor Addison House, Guy’s Campus, SE1 1UL, London, UK;Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King’s College London, 2nd Floor Addison House, Guy’s Campus, SE1 1UL, London, UK;Guy’s and St. Thomas’s National Health Service Foundation Trust, London, UK;Guy’s and St. Thomas’s National Health Service Foundation Trust, London, UK;

关键词: Fracture neck of femur;    Ambulation;    Acute care;    Key performance indicators;    Quality improvement;    Audit;    Competing risk;    Rehabilitation;   

DOI  :  10.1186/s12877-021-02624-w

来源: Springer

【 摘 要 】

BackgroundEarly mobilisation leads to a two-fold increase in the adjusted odds of discharge by 30-days compared to late mobilisation. Whether this association varies by patient characteristics identified as reasons for delayed mobilisation is unknown.MethodsAudit data was linked to hospitalisation records for 133,319 patients 60 years or older surgically treated for hip fracture in England or Wales between 2014 and 2016. Adjusted proportional odds regression models tested whether the cumulative incidences of discharge differed between those mobilised early and those mobilised late for subgroups defined by dementia, delirium, hypotension, prefracture ambulation, and prefracture residence, accounting for the competing risk of death.ResultsOverall, 34,253 patients presented with dementia, 9818 with delirium, and 10,123 with hypotension. Prefracture, 100,983 were ambulant outdoors, 30,834 were ambulant indoors only, 107,144 were admitted from home, and 23,588 from residential care. 1502 had incomplete data for ambulation and 2587 for prefracture residence. 10, 8, 8, 12, and 12% fewer patients with dementia, delirium, hypotension, ambulant indoors only prefracture, or admitted from residential care mobilised early when compared to those who presented without dementia, delirium, hypotension, with outdoor ambulation prefracture, or admitted from home. The adjusted odds ratios of discharge by 30-days postoperatively among those who mobilised early compared with those who mobilised late were 1.71 (95% CI 1.62–1.81) for those with dementia, 2.06 (95% CI 1.98–2.15) without dementia, 1.56 (95% CI 1.41–1.73) with delirium, 2.00 (95% CI 1.93–2.07) without delirium, 1.83 (95% CI, 1.66–2.02) with hypotension, 1.95 (95% CI, 1.89–2.02) without hypotension, 2.00 (95% CI 1.92–2.08) with outdoor ambulation prefracture, 1.80 (95% CI 1.70–1.91) with indoor ambulation only prefracture, 2.30 (95% CI 2.19–2.41) admitted from home, and 1.64 (95% CI 1.51–1.77) admitted from residential care, accounting for the competing risk of death.ConclusionIrrespective of dementia, delirium, hypotension, prefracture ambulation or residence, early compared to late mobilisation increased the likelihood of hospital discharge by 30-days postoperatively. However, fewer patients with dementia, delirium, or hypotension, poorer prefracture ambulation, or from residential care mobilised early. There is a need reduce this care gap by ensuring sufficient resource to enable all patients to benefit from early mobilisation.

【 授权许可】

CC BY