The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery

Morten Tange Kristensen; Ruqayyah Turabi; Katie J. Sheehan

doi:10.1177/02692155241231225

The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery

Morten Tange Kristensen^*, Ruqayyah Turabi, Katie J. Sheehan

^*Corresponding author for this work

Population Health Sciences

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	990-997
Number of pages	8
Journal	Clinical Rehabilitation
Volume	38
Issue number	7
DOIs	https://doi.org/10.1177/02692155241231225
Publication status	Published - Jul 2024

Keywords

Ambulation
death
fracture neck of femur
physiotherapy
rehabilitation

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10.1177/02692155241231225

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title = "The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery",

abstract = "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.",

keywords = "Ambulation, death, fracture neck of femur, physiotherapy, rehabilitation",

author = "Kristensen, {Morten Tange} and Ruqayyah Turabi and Sheehan, {Katie J.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = jul,

doi = "10.1177/02692155241231225",

language = "English",

volume = "38",

pages = "990--997",

journal = "Clinical Rehabilitation",

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T1 - The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery

AU - Kristensen, Morten Tange

AU - Turabi, Ruqayyah

AU - Sheehan, Katie J.

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2024/7

Y1 - 2024/7

N2 - 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.

AB - 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.

KW - Ambulation

KW - death

KW - fracture neck of femur

KW - physiotherapy

KW - rehabilitation

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U2 - 10.1177/02692155241231225

DO - 10.1177/02692155241231225

M3 - Article

C2 - 38347704

AN - SCOPUS:85185658993

SN - 0269-2155

VL - 38

SP - 990

EP - 997

JO - Clinical Rehabilitation

JF - Clinical Rehabilitation

IS - 7

ER -

The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery

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