Does delay to theatre influence patients' ability to achieve early mobilisation following surgical fixation of a hip fracture?

Purpose

The National Hip Fracture Database (NHFD) publishes performance data which includes achievement of early post-operative mobility - defined as 'Mobilised on day of, or day following, surgery'.

It had been anecdotally noted on our Orthopaedic trauma unit that patients who experience a delay to surgery find it more difficult to achieve this early mobility target (with 'delay' to surgery defined here as failure to meet the NICE clinical guideline for hip fracture: 'Perform surgery on the day of, or the day after, admission').

This study therefore aimed to objectively investigate this supposition.

Achievement of the NHFD mobility target was significantly higher at 92%
for patients who had surgery within the NICE recommended timescale.
This was in comparison to 77%
of patients achieving early mobility in the group who experienced a 'delay' to theatre.

Approach

Relevant data was collected retrospectively for all patients admitted to our acute hospital site for surgical fixation of a hip fracture over a one year period; resulting in a sample of 287 patients. All patients in the sample had received Physiotherapy assessment on the day following surgery.

Outcomes

73 (25%) of the 287 cases achieved the NICE guideline's timescale for access to surgery.

Achievement of the NHFD mobility target was significantly higher at 92% for patients who had surgery within the NICE recommended timescale. This was in comparison to 77% of patients achieving early mobility in the group who experienced a 'delay' to theatre.

214 cases experienced delay to surgery - 41% due to medical reasons and 59% for non-medical factors. Achievement of the NHFD mobility target was similar in both groups - at 76% and 78% respectively.

Patients who do not access theatre within the NICE recommended timescale for surgical management of their hip fracture are less likely to achieve the NHFD mobility target.

The reason for the delay to theatre, however, does not seem to affect the patient's likelihood of achieving early mobility.

Implications

The project results have been shared within the Orthopaedic directorate at our Trust; and highlight some of the post-operative effect of pre-operative delays.

It may be reasonable to extrapolate that increased time to achieve post-operative mobilisation would lead to a consequent increase in length of hospital stay; and furthermore may impact upon overall functional outcomes for the patients involved. However, these factors were not included in this current study, and so further project work is being planned to explore these aspects of this topic.

Fund acknowledgements

There were no cost implications to completion of this project.

Additional notes

This work was presented at Physiotherapy UK 2019.

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