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Early Surgical Intervention Enhances Ambulatory Function at Discharge and
Increases the Likelihood of Returning to Preinjury Residence in Older Patients
With Hip Fractures
#MMPMID41220605
Kawakami H
; Sasaki H
; Kamizono J
; Fujimoto Y
; Taniguchi N
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41220605
show ga
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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