Key result
Early mobilisation within 36 hours of hip fracture surgery increased the adjusted odds of hospital discharge by 30 days compared to late mobilisation (OR 1.93; 95% CI 1.86-1.99).
Why the study?
NICE guidelines recommend mobilisation on the day after hip fracture surgery based on limited small trials, highlighting the need for additional evidence to support early mobilisation as a UK Best Practice Tariff.
Does early mobilisation within 36 hours of surgery improve hospital discharge by 30-days in patients 60 years or older undergoing hip fracture surgery?
Observational (n=135,105)
Yes
Does early mobilisation within 36 hours of surgery improve hospital discharge by 30-days in patients 60 years or older undergoing hip fracture surgery?
Odds Ratio: 1.93 (95% CI 1.86–1.99)
Absolute Event Rate: 65.2% vs 44.5%
Early mobilisation within 36 hours of hip fracture surgery is associated with a nearly two-fold increase in the adjusted odds of hospital discharge by 30 days.
Background To maximise the benefits of hip fracture surgery the National Institute for Health and Care Excellence Clinical Guideline recommends mobilisation on the day after hip fracture surgery based a low to moderate quality trial with a small sample size. There is a need to generate additional evidence to support early mobilisation as a new UK Best Practice Tariff (BPT). Objective To determine whether mobilisation timing was associated with the cumulative incidence of hospital discharge by 30-days after hip fracture surgery, accounting for potential confounders and the competing risk of in-hospital death. Method We examined data for 135,105 patients 60 years or older who underwent surgery for nonpathological first hip fracture between January 2014 and December 2016 in any hospital in England or Wales. We tested whether the cumulative incidences of discharge differed between those mobilised early (within 36 hours of surgery) and those mobilised late accounting for potential confounders and the competing risk of in-hospital death. Results 106,722 (79%) of patients first mobilised early. The average rate of discharge was 60.1 (95% CI 59.8–60.5) per 1,000 patient days, varying from 65.2 (95% CI 64.8–65.6) among those who mobilised early to 44.5 (95% CI 43.9–45.1) among those who mobilised late, accounting for the competing risk of death. By 30-days postoperatively, the crude and adjusted odds ratios of discharge were 2.26 (95% CI 2.2–2.32) and 1.93 (95% CI 1.86–1.99) respectively among those who first mobilised early compared to those who mobilised late, accounting for the competing risk of death. Conclusion Early mobilisation led to a near two fold increase in the adjusted odds of discharge by 30-days postoperatively. We recommend inclusion of mobilisation within 36 hours of surgery as a new UK BPT to help reduce delays to mobilisation currently experienced by one-fifth of patients surgically treated for hip fracture.
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Goubar et al. (2021) conducted an observational in Hip fracture (n=135,105). Early mobilisation (within 36 hours of surgery) vs. Late mobilisation was evaluated on Cumulative incidence of hospital discharge by 30-days after hip fracture surgery (OR 1.93, 95% CI 1.86-1.99). Early mobilisation within 36 hours of hip fracture surgery increased the adjusted odds of hospital discharge by 30 days compared to late mobilisation (OR 1.93; 95% CI 1.86-1.99).
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