While the importance of timely surgery and early mobilization are understood in geriatric
fracture populations, the relationship between timing of initiation of physical therapy
(PT) postoperatively on length of stay (LOS) and mortality has not been well delineated.
The purpose of this investigation was to determine the effect of PT initiated on postoperative
day zero (POD0) on LOS and mortality in geriatric hip fracture patients.
Materials and Methods
Patients aged 60 and over who underwent hip fracture surgery, including arthroplasty
or internal fixation, between January 2017 and December 2019 at three affiliated academic
hospitals were identified. Retrospective chart review and review of hospital charges
were used to determine patient demographics, Charlson Comorbidity Index (CCI), surgery
performed, timing of postoperative PT visits, LOS, and mortality.
Of 1,551 patients identified that met inclusion criteria, 83 (5.3%) received PT on
POD0. Most patients (76.3%) received PT on postoperative day 1 (POD1), and 18.4% received
first PT on postoperative day 2 or later (POD2+). Time from admission to surgery,
CCI, sex, and BMI did not differ significantly between groups. The age difference
between patients in the POD0 and the POD1/POD2+ groups was statistically significant
with the mean age in the POD1/2+ group being 2.3 years older than the POD0 group (p=0.045). There was no difference in postoperative length of stay (PLOS) based on type of
fixation. The average PLOS was 3.4 days in the POD0 PT group compared to 5.2 days
in the POD1 group (p<0.0001) and 8.2 days in the POD2+ group (p<0.0001). The POD0/1 group had significantly lower mortality than the POD2+ group [3.7% vs.
9.8%, OR 0.354 (95% CI 0.217-0.575), p<0.0001].
Earlier initiation of PT postoperatively is associated with significantly shorter
total and postoperative LOS and initiation of PT before POD2 is associated with decreased
30-day mortality. Each day that initiation of PT is delayed is associated with a two-
to three-day increase in LOS.