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March 10, 1997

What Is the Role of Timing in the Surgical and Rehabilitative Care of Community-Dwelling Older Persons With Acute Hip Fracture?

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).

Arch Intern Med. 1997;157(5):513-520. doi:10.1001/archinte.1997.00440260055009

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