Aims Early mobilisation without restrictions on weight-bearing promotes physical function, prevents complications and reduces the length of hospital stay. This study explored factors that negatively impact the ability to mobilise on day one following hip fracture surgery.
Methods At a single-site major teaching hospital in Australia, 152 electronic medical records for adults who had hip fracture surgery between Jan 2021 and May 2022 were reviewed. Data regarding demographics, co-morbidities, surgery type, anaesthetic type, functional assessment, and postoperative complications was collected. The primary outcome was evidence of mobility day one following surgery, per recommendations in the Australian and New Zealand Guideline for Hip Fracture Care.
Results 49% of participants mobilised on day one post-surgery. Premorbid predictors of unsuccessful day one mobilisation (p<0.05) included: mobility with an aid (RR 2.58, CI 1.5-4.3), residing in an aged care facility (RR 1.86, CI 1.4-2.4) and cognitive impairment (RR 1.93, CI 1.4-2.6). Moderately frail participants had a reduced likelihood of mobilising compared to mildly frail participants. Acute issues that were significantly associated with reduced mobility postoperatively (p<0.05) included: delirium (RR 2.61, CI 1.9-3.5), hypotension (RR 1.91, CI 1.4-2.5) or moderate to severe pain (RR 1.98, CI 1.4-2.8). Depression and time to surgery did not significantly affect early mobilisation.
Conclusions Low pre-fracture functional ability, acute peri-operative issues and environmental factors impact postoperative mobility. By identifying patients less likely to mobilise peri-operatively, modifiable risk factors such as delirium can be more stringently monitored for and managed, leading to earlier mobilisation and improved physical function and independence.