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What Is the Role of Timing in the Surgical and Rehabilitative Care of Community-Dwelling Older Persons With Acute Hip Fracture?
Helen Hoenig, MD, MPH;
Lisa V. Rubenstein, MD, MSPH;
Richard Sloane, MPH;
Ronnie Horner, PhD;
Katherine Kahn, MD
Arch Intern Med. 1997;157(5):513-520.
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 underwent early surgical repair 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.
Arch Intern Med. 1997;157:513-520
Author Affiliations
From the Physical Medicine and Rehabilitation Service (Dr Hoenig), and the Center for Health Services Research in Primary Care, HSR&D Field Program (Mr Sloane and Dr Horner), Durham Veterans Administration Medical Center, Durham, NC; the Department of Medicine, Duke University Medical Center, Durham (Drs Hoenig and Horner); the Center for the Study of Health Care Provider Behavior, HSR&D Field Program, Sepulveda Veterans Administration Medical Center, Sepulveda, Calif (Dr Rubenstein); the Department of Medicine, University of California at Los Angeles (Drs Rubenstein and Kahn); and the Health, Education and Welfare Department, Health Sciences Program, RAND, Santa Monica, Calif (Drs Rubenstein and Kahn).
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