This study aimed to identify the factors that influence the initiation of walking within 2 days after hip fracture surgery.
The subjects were 124 patients who had undergone hip fracture surgery at our hospital and could walk indoors preoperatively. Exclusion criteria were fractures in other parts of the body at the time of injury, postoperative delirium, postoperative complications, and postoperative periods of unloading. 101 patients who met these criteria were included in the analysis. Patients were classified into two groups: early walkers (able to start walking within two days after surgery, either in the parallel bars or with a walker) and delayed walkers (did not start walking after the third postoperative day). The survey items included age, gender, BMI, fracture type, Functional Comorbidity Index Score, pre-injury New Mobility Score (NMS), number of days waiting for surgery, Abbreviated Mental Test Score (AMTS) on admission, Geriatric Nutritional Risk Index, intra-operative blood loss, the difference in hemoglobin levels (preoperative and day after surgery), preoperative Blood Urea-Nitrogen to Creatinine ratio, presence of fever in the first two postoperative days and presence of orthostatic hypotension For statistical analysis, multiple logistic regression analysis with a stepwise method was used, with the dependent variable being the presence or absence of early ambulation and the independent variables being each survey item. Cut-off values were calculated if a continuous variable was selected. The significance level was set at p = 0.05.
Sixty-five patients (64.35%) were in the early walking group and 36 (35.64%) were in the delayed walking group after hip fracture surgery. Multiple logistic regression analysis showed that pre-injury NMS (odds ratio: 1.48, 95% CI: 1.14-1.95) and AMTS on admission (odds ratio: 1.23, 95% CI: 1.04-1.46) were associated with early walking. The ROC curves showed that the cut-off values for the NMS were 5.00 points and for the AMTS on admission were 5.00 points (NMS: AUC: 0.74, sensitivity: 0.938, specificity: 0.500; and AMST: AUC: 0.77, sensitivity: 0.723, specificity: 0.722).
Pre-injury mobility and cognitive function on admission may be important factors in identifying patients who will start walking within 2 days after hip fracture surgery. Future studies must investigate effective physiotherapy interventions to achieve early postoperative gait initiation.
Assessment of pre-injury mobility and cognitive function may be used to predict early ambulation following hip fracture surgery. Information should be shared with multidisciplinary staff to provide physiotherapy interventions to prevent deterioration of physical function with the aim of early gait initiation in cases where a delay in gait initiation is anticipated.
Walking ability
Predictor
