Impact of early postoperative ambulation on gait recovery after hip fracture surgery: A multicenter cohort study

Objective: This study aimed to investigate the effect of early postoperative ambulation on gait recovery at the initial postoperative week and at discharge after hip fracture surgery in older patients. Design: Multicenter prospective cohort study. Setting and Participants: The study included 882 patients aged ≥65 years from 10 acute hospitals in Japan. Methods: Patients were divided into two groups according to the interval between surgery and first ambulation: early-ambulation (EA) group (initiation of ambulation on postoperative day 1 or 2) and late-ambulation (LA) group (initiation of ambulation on postoperative day 3 or later). The Functional Independence Measure (FIM) was assessed 1 day postoperatively, 1 week postoperatively, and at discharge. Independent walking regardless of use of walking aids was defined as walking FIM ³5. Confounding variables were age, mobility and cognitive function before injury, medical history, fracture type, and waiting days for surgery. Multivariate logistic regression analysis was conducted to determine whether EA affected independent walking at 1 week postoperatively and at discharge. Results: The number of patients in the EA and LA groups was 292 (33.1%) and 590 (66.9%), respectively. The number of patients walking independently 1 week postoperatively and at discharge was 156 (17.7%) and 292 (33.1%), respectively. Multivariate logistic regression analysis revealed that EA was associated with independent walking at 1 week postoperatively (odds ratio [OR], 3.27; 95% confidence interval [CI], 2.17-4.94; P < .0001) and at discharge after adjusting for confounders (OR, 3.33; 95% CI, 2.38-4.69; P < .0001). EA was associated with the recovery to pre-injury walking status at discharge after adjusting for confounders (OR, 3.05; 95% CI, 1.59–5.93; P =.0009). Conclusion and Implications: Early ambulation after hip fracture surgery has an impact on independent walking and recovery of pre-injury walking status at 1 week postoperatively and at discharge from acute hospitals in older patients.