Key result
Early surgery within 48 hours linked to better discharge locomotion scores in older hip fractures.
Why the study?
With an aging population and more individuals living in nursing homes, the effect of early hip fracture surgery on ambulatory function and returning to preinjury residence needed assessment.
Does early surgical intervention (within 48 hours) improve ambulatory function at discharge and increase the likelihood of returning to preinjury residence in older patients with hip fractures?
Cohort (n=455)
No
Does early surgical intervention (within 48 hours) improve ambulatory function at discharge and increase the likelihood of returning to preinjury residence in older patients with hip fractures?
Absolute Event Rate: 5.35% vs 4.68%
p-value: p=0.04
Early surgical intervention for hip fractures in older adults preserves ambulatory function at discharge, which is a key predictor of returning to preinjury residence.
May support expedited surgery to preserve locomotion at discharge; leaves open effects on residence return and requires RCT confirmation.
Background: As the global population ages, an increasing number of older individuals reside in nursing homes, underscoring the need to include this group in discharge outcome analyses. The aim of this study was to assess the effect of early surgical intervention (defined as surgery within 48 hours of injury) on ambulatory function at discharge and the likelihood of returning to the preinjury residence, including discharge to nursing homes, among patients with hip fractures. Methods: We retrospectively analyzed 455 patients who underwent open reduction and internal fixation (ORIF) for hip fractures at our institution between April 2017 and March 2023. Patients were categorized into 2 groups based on the timing of surgery: the "early group" (within 48 hours) and the "delayed group" (after 48 hours). Results: The early group included 338 patients, while the delayed group included 117 patients. The mean functional independence measure (FIM) (locomotion) score at discharge was 5.35 in the early group and 4.68 in the delayed group (p = 0.04). Spearman correlation coefficient between early surgical intervention and FIM (locomotion) at discharge was 0.097 (p < 0.05). Multiple regression analysis revealed a regression coefficient of 0.63 (p = 0.02) for early surgical intervention with respect to FIM (locomotion) at discharge. Furthermore, logistic regression analysis indicated that the higher FIM (locomotion) score at discharge was associated with an increased likelihood of returning to the preinjury residence (regression coefficient = 0.30, p < 0.001). Conclusions: Early surgical intervention was associated with improved FIM (locomotion) scores at discharge. Higher FIM (locomotion) scores at discharge were correlated with an increased likelihood of returning to the preinjury residence. These findings underscore the importance of early functional recovery in older patients undergoing ORIF for hip fractures, as surgical delays can hinder the restoration of activities of daily living. Therefore, where feasible, early ORIF should be prioritized to optimize patient outcomes. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Kawakami et al. (2025) conducted a cohort in Femoral trochanteric fractures (n=455). Early surgical intervention (within 48 hours of injury) vs. Delayed surgical intervention (after 48 hours) was evaluated on Functional Independence Measure (FIM) locomotion score at discharge (p=0.04). Early surgical intervention within 48 hours of injury significantly improved the mean FIM locomotion score at discharge compared to delayed surgery (5.35 vs. 4.68) in older patients with hip fractures.
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