What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture?

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 B-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.