Early mobilisation reduces the risk of in-hospital mortality following hip fracture

Key Summary PointsAim To identify the determinants of in-hospital mortality post-hip fracture in Ireland 2013-2017. Findings Older males with poor pre-fracture mobility who were not mobilised on the day of/after surgery had the highest risk of in-hospital mortality. Message Early mobilisation on the day of/after surgery should be added as a new formal hip fracture standard of care in keeping with best international practice. Purpose Hip fractures are associated with considerable morbidity, excess mortality, and significant healthcare expenditure. There are approximately 3700 hip fractures in Ireland per annum and this figure is set to rise in the next decade in parallel with the ageing population. Approximately 5% of patients who sustain a hip fracture will die in hospital, with less than half of survivors regaining their pre-operative level of function. The authors aimed to identify the determinants of in-hospital mortality post-hip fracture in Ireland 2013-2017. Methods A secondary analysis of 15,603 patients in the Irish Hip Fracture Database (IHFD) was conducted. Both descriptive and analytical statistics were produced. Univariate and multivariate logistic regression was carried out. Results 31% (n = 4796) of patients were male and 69% (n = 10,807) were female. Mean age for males was 75 years (SD 13.5) and 79 years for females (SD 10.5). Median in-hospital mortality was 4.7% (n = 711) (range 2.7-6.2). Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality; however, only four remained statistically significant on multivariate analysis [not mobilised day of/after surgery (OR 1.46, 95% CI 1.25-1.70,p < 0.001), independent mobility pre-fracture (OR 0.84, 95% CI 0.79-0.89,p < 0.001), female gender (OR 0.56, 95% CI 0.41-0.76,p < 0.001), and older age (OR 1.05, 95% CI 1.03-1.06,p < 0.01)]. Conclusion Older males with poor pre-fracture mobility who were not mobilised on the day of/after surgery had the highest risk of in-hospital mortality. This research supports the adoption of early mobilisation (day of/after surgery) as a new formal hip fracture standard in keeping with best international practice.