To examine whether first-day mobilization opportunities reduce the occurrence of in-hospital complications.
This observational cohort study used person-level data from the Australian and New Zealand Hip Fracture Registry (ANZHFR) and the New South Wales Admitted Patient Data Collection (APDC) from 2015 to 2018. The cohort included patients aged 50 or above, admitted with fragility hip fractures to 21 hospitals in New South Wales, Australia.
First-day mobilization opportunities included activities such as transferring in/out of bed, stepping, or walking. Patients who were deemed too unwell to mobilize by the clinical team or who declined to mobilize were still included if given the opportunity.
Data were collected on 26 in-hospital complications, including 12 hospital-acquired complications (HACs) defined by the Australian Commission on Safety and Quality in Health Care (ACSQHC). These HACs are high-priority complications that incur financial penalties in Australia.
The association between first-day mobilization opportunities and complication incidence was assessed using modified Poisson regression models. Both univariable and multivariable associations were examined. The multivariable analysis adjusted for person-level prognostic factors, including age, sex, residency in aged care facilities, pre-admission mobility status, cognitive status, and the Charlson Comorbidity Index.
Of the 7,949 eligible patients, 88% (n=7,022) received a first-day mobilization opportunity. Fifty-eight percent experienced at least one in-hospital complication, with 35% experiencing at least one ACSQHC-defined HAC.
Patients who received a first-day mobilization opportunity had a 13% reduced risk (95% confidence interval, 95%CI: 9% to 17%) of developing an in-hospital complication compared to those who did not. After adjusting for person-level prognostic factors, the risk reduction was 5% (95%CI: 1% to 9%). Additionally, first-day mobilization was associated with a 22% reduction (95%CI: 15% to 28%) in ACSQHC-HACs in unadjusted analyses, and a 12% reduction (95%CI: 6% to 18%) after adjusting for prognostic factors.
In patients who underwent hip fracture surgery, first-day mobilization was associated with a reduced incidence of in-hospital complications. This association was stronger for the more severe, high-priority ACSQHC-HACs, highlighting the importance of early mobilization post-surgery.
Our findings support the implementation of seven-day physiotherapy services for hip fracture patients to reduce post-operative complications.
hip fracture surgery
complication
