Early hip fracture surgery and rehabilitation. How to improve functional quality outcomes. A retrospective study

Abstract

Introduction: Hip fractures are one of the major disability causes associated with a high morbidity and mortality rate. Early surgery and stable fixation could be associated with better pain control, possibly lower mortality rates, and early recovery of autonomy. Aim: The aim of this study was to analyze a population affected by hip fractures exploring the effects of an early surgery and rehabilitation approach in relation to functional outcomes. Materials and methods: This study included 140 adult patients (mean age 79.35±11.71, range 66-94 years) with hip fractures admitted to the orthopedic unit of the University Hospital of Messina who underwent surgery and a rehabilitation program while hospitalized. Exclusion criteria were patients not surgically treated or discharged with no rehabilitation sessions. Clinical outcomes were evaluated post-surgery and before discharge as follows: pain quantification using the visual analogue scale and functional evaluation using the Barthel Index. A rehabilitation protocol was started within 48 hours after surgery. Results: The study sample resulted in 140 patients. Eighty-seven of them (63.14%) underwent hip replacement surgery, and 53 patients (37.86%) underwent internal fixation surgery. The greater part of the sample (68.42%) had surgery within 48 hours. Patients with more comorbidities had worse clinical outcomes, as shown by the Barthel Index, timing of verticalization and walking, and pain control. Between admission and discharge, the Barthel Index score improved, as did the pain complained of by most patients. Conclusions: A direct connection between orthopedics and the rehabilitation team, even after discharge, should be established and promptly organized to gain the best clinical outcomes. Indeed, we propose the triad early verticalization, pain control, and Barthel Index as a possible tool to define functional quality outcomes in post hip fracture surgery.