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Arch Intern Med. 1997 Mar 10;157(5):513-20.

What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture?

Author information

1
Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, NC, USA.

Erratum in

  • Arch Intern Med 1997 Jul 14;157(13):1444.

Abstract

OBJECTIVE:

To determine the relationship of surgical repair of acute hip fracture within 2 days of hospital admission, followed by more than 5 sessions per week of physical and occupational therapy (PT/OT), to outcomes after acute hip fracture.

DESIGN:

Comparison of hip fracture outcomes via secondary analysis of data obtained by retrospective medical record review according to timing of surgical repair and frequency of PT/OT, adjusted for patient, medical care, and hospital characteristics.

SAMPLE:

The study included the medical records of 1880 elderly Medicare recipients admitted from the community to 284 acute care hospitals in 5 states during 1981 and 1982 or 1985 and 1986 with a primary diagnosis of acute hip fracture who underwent surgical repair and received PT/OT.

INTERVENTIONS:

None.

MAIN OUTCOME MEASURES:

The postoperative day when ambulation first occurred, the length of hospital stay, and return to the community.

RESULTS:

Earlier surgical repair was associated with a shorter length of hospital stay (5 fewer days, P < .001) without a statistically significant increase in medical complications. High frequency PT/OT was associated with earlier ambulation (odds ratio [OR], 1.76; 95% confidence limits [CL], 1.50, 2.07). Patients who ambulated earlier [corrected] had shorter lengths of stay (6.5 fewer days, P < .001), were more likely to return to the community (OR, 1.45; 95% CL, 1.16, 1.81), and had better 6-month survival (OR, 2.8; 95% CL, 2.06, 3.88), and patients younger than 85 years had fewer in-hospital complications (11% vs 4%, P < .001).

CONCLUSION:

Surgical repair within the first 2 days of hospitalization and more than 5 PT/OT sessions per week were associated with better health outcomes in a nationally representative sample of elderly patients with hip fracture.

Comment in

PMID:
9066455
[Indexed for MEDLINE]

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