Timing of surgery and exercise training of hip fracture in the elderly_West China Medical Journal

Authors：

GAO Feng ,  DUAN Xin , LIU Jiaxin , ZHANG Xiang

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

DUAN Xin, Email: dxbaal@hotmail.com

Keywords：

Hip fracture; Enhanced recovery after surgery; Timing of surgery; Functional exercise; Preoperative physical activity

DOI：

10.7507/1002-0179.202007366

Video：

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Hip fracture in the elderly is a disease with a high mortality rate and a high complication rate. Its main treatment method is surgery. The concept of enhanced recovery after surgery runs through the perioperative period of elderly patients with hip fracture. Elderly patients with hip fracture should be scheduled for surgery as soon as possible after admission to enhance postoperative functional recovery. Preoperative ambulation and postoperative exercise can reduce postoperative complications and mortality, shorten the length of hospital stay, and promote functional recovery.

Citation： GAO Feng, DUAN Xin, LIU Jiaxin, ZHANG Xiang. Timing of surgery and exercise training of hip fracture in the elderly. West China Medical Journal, 2020, 35(10): 1263-1266. doi: 10.7507/1002-0179.202007366 Copy

1.	Proudfoot S, Bennett B, Duff S, et al. Implementation and effects of enhanced recovery after surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services. N Z Med J, 2017, 130(1455): 77-90.
2.	张建政, 王晓伟, 刘智, 等. 关注老年髋部骨折病死率过高的问题. 中国骨与关节杂志, 2018, 7(7): 481-483.
3.	中国老年医学学会骨与关节分会创伤骨科学术工作委员会. 老年髋部骨折诊疗专家共识(2017). 中华创伤骨科杂志, 2017, 19(11): 921-927.
4.	邱贵兴, 裴福兴, 胡侦明, 等. 中国骨质疏松性骨折诊疗指南—骨质疏松性骨折诊断及治疗原则. 黑龙江科学, 2018, 9(2): 85-88, 95.
5.	李宁, 杨明辉, 李新萍, 等. 老年髋部骨折中“骨折联络服务”的初步临床效果. 骨科临床与研究杂志, 2017, 2(5): 287-292.
6.	Wong SHJ, Fang XC, Yee KHD, et al. Hip fracture time-to-surgery and mortality revisited: mitigating comorbidity confounding by effect of holidays on surgical timing. Int Orthop, 2018, 42(8): 1789-1794.
7.	Majumdar SR, Beaupre LA, Johnston DW, et al. Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study. Med Care, 2006, 44(6): 552-559.
8.	Turesson E, Ivarsson K, Thorngren KG, et al. Hip fractures: treatment and functional outcome. The development over 25 years. Injury, 2018, 49(12): 2209-2215.
9.	Bohm E, Loucks L, Wittmeier K, et al. Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority. Can J Surg, 2015, 58(4): 257-263.
10.	Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190, 000 patients. PLoS One, 2012, 7(10): e46175.
11.	Ftouh S, Morga A, Swift C, et al. Guidelines: management of hip fracture in adults: summary of NICE guidance. BMJ, 2011, 342: d3304.
12.	Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth, 2008, 55(3): 146-154.
13.	Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA, 2004, 291(14): 1738-1743.
14.	Rademakers LM, Vainas T, van Zutphen SW, et al. Pressure ulcers and prolonged hospital stay in hip fracture patients affected by time-to-surgery. Eur J Trauma Emerg Surg, 2007, 33(3): 238-244.
15.	HIP ATTACK Investigators. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet, 2020, 395(10225): 698-708.
16.	Greve K, Modig K, Talbäck M, et al. No association between waiting time to surgery and mortality for healthier patients with hip fracture: a nationwide Swedish cohort of 59, 675 patients. Acta Orthop, 2020, 91(4): 396-400.
17.	Orosz GM, Hannan EL, Magaziner J, et al. Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc, 2002, 50(8): 1336-1340.
18.	Larsson G, Strömberg RU, Rogmark C, et al. Prehospital fast track care for patients with hip fracture: impact on time to surgery, hospital stay, post-operative complications and mortality a randomised, controlled trial. Injury, 2016, 47(4): 881-886.
19.	Schermann H, Gurel R, Rotman D, et al. Regulatory measures expedited hip fracture surgery without lowering overall patient mortality. J Am Geriatr Soc, 2019, 67(4): 777-783.
20.	Dinah AF. Reduction of waiting times in A& E following introduction of “fast-track” scheme for elderly patients with hip fractures. Injury, 2003, 34(11): 839-841.
21.	杨明辉, 吴新宝, 龚晓峰, 等. 骨科与老年科共管模式治疗老年髋部骨折及与英国的比较. 中国骨与关节杂志, 2017, 6(3): 169-173.
22.	Chacko AT, Ramirez MA, Ramappa AJ, et al. Does late night hip surgery affect outcome?. J Trauma, 2011, 71(2): 447-453.
23.	Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med, 2001, 345(9): 663-668.
24.	Kent SJ, Adie S, Stackpool G. Morbidity and in-hospital mortality after hip fracture surgery on weekends versus weekdays. J Orthop Surg (Hong Kong), 2016, 24(1): 41-44.
25.	Foss NB, Kehlet H. Short-term mortality in hip fracture patients admitted during weekends and holidays. Br J Anaesth, 2006, 96(4): 450-454.
26.	Rashid RH, Zubairi AJ, Slote MU, et al. Hip fracture surgery: does time of the day matter? A case-controlled study. Int J Surg, 2013, 11(9): 923-925.
27.	Taylor M, Hopman W, Yach J. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room. Can J Surg, 2016, 59(5): 337-341.
28.	Sheikh HQ, Aqil A, Hossain FS, et al. There is no weekend effect in hip fracture surgery. A comprehensive analysis of outcomes. Surgeon, 2018, 16(5): 259-264.
29.	Nijland L, Karres J, Simons AE, et al. The weekend effect for hip fracture surgery. Injury, 2017, 48(7): 1536-1541.
30.	Asheim A, Nilsen SM, Toch-Marquardt M, et al. Time of admission and mortality after hip fracture: a detailed look at the weekend effect in a nationwide study of 55, 211 hip fracture patients in Norway. Acta Orthop, 2018, 89(6): 610-614.
31.	Lewis PM, Waddell JP. When is the ideal time to operate on a patient with a fracture of the hip? A review of the available literature. Bone Joint J, 2016, 98-B(12): 1573-1581.
32.	Yonezawa T, Yamazaki K, Atsumi T, et al. Influence of the timing of surgery on mortality and activity of hip fracture in elderly patients. J Orthop Sci, 2009, 14(5): 566-573.
33.	Öztürk B, Johnsen SP, Röck ND, et al. Impact of comorbidity on the association between surgery delay and mortality in hip fracture patients: a Danish nationwide cohort study. Injury, 2019, 50(2): 424-431.
34.	Mitchell SM, Chung AS, Walker JB, et al. Delay in hip fracture surgery prolongs postoperative hospital length of stay but does not adversely affect outcomes at 30 Days. J Orthop Trauma, 2018, 32(12): 629-633.
35.	Lawrence JE, Fountain DM, Cundall-Curry DJ, et al. Do patients taking warfarin experience delays to theatre, longer hospital stay, and poorer survival after hip fracture?. Clin Orthop Relat Res, 2017, 475(1): 273-279.
36.	Zehir S, Zehir R, Sarak T. Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy. Acta Orthop Traumatol Turc, 2015, 49(3): 249-254.
37.	Tan C, Saito N, Miyawaki I, et al. Preoperative circadian physical activity rhythm and postoperative delirium in cardiovascular surgery patients. Chronobiol Int, 2020, 37(7): 1059-1066.
38.	Vasta S, Papalia R, Torre G, et al. The influence of preoperative physical activity on postoperative outcomes of knee and hip arthroplasty surgery in the elderly: a systematic review. J Clin Med, 2020, 9(4): 969.
39.	Nilsson H, Angerås U, Bock D, et al. Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer. BMJ Open, 2016, 6(1): e007997.
40.	Pouwels S, Fiddelaers J, Teijink JA, et al. Preoperative exercise therapy in lung surgery patients: a systematic review. Respir Med, 2015, 109(12): 1495-1504.
41.	Valkenet K, van de Port IG, Dronkers JJ, et al. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil, 2011, 25(2): 99-111.
42.	刘佳鑫, 陈力, 段鑫, 等. 术前早期下地活动对老年髋部骨折患者术后生活自理能力的影响. 中国修复重建外科杂志, 2019, 33(3): 318-322.
43.	Magaziner J, Mangione KK, Orwig D, et al. Effect of a multicomponent home-based physical therapy intervention on ambulation after hip fracture in older adults: the CAP randomized clinical trial. JAMA, 2019, 322(10): 946-956.
44.	Cheung WH, Shen WY, Dai DL, et al. Evaluation of a multidisciplinary rehabilitation programme for elderly patients with hip fracture: a prospective cohort study. J Rehabil Med, 2018, 50(3): 285-291.
45.	Host HH, Sinacore DR, Bohnert KL, et al. Training-induced strength and functional adaptations after hip fracture. Phys Ther, 2007, 87(3): 292-303.
46.	Binder EF, Brown M, Sinacore DR, et al. Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA, 2004, 292(7): 837-846.
47.	Mangione KK, Craik RL, Tomlinson SS, et al. Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home?. Phys Ther, 2005, 85(8): 727-739.
48.	龙也, 李浪, 王通, 等. 老年转子间骨折术后早期功能锻炼的效果研究. 华西医学, 2018, 33(9): 1124-1127.
49.	Milte R, Miller MD, Crotty M, et al. Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture. J Rehabil Med, 2016, 48(4): 378-385.

1. Proudfoot S, Bennett B, Duff S, et al. Implementation and effects of enhanced recovery after surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services. N Z Med J, 2017, 130(1455): 77-90.
2. 张建政, 王晓伟, 刘智, 等. 关注老年髋部骨折病死率过高的问题. 中国骨与关节杂志, 2018, 7(7): 481-483.
3. 中国老年医学学会骨与关节分会创伤骨科学术工作委员会. 老年髋部骨折诊疗专家共识(2017). 中华创伤骨科杂志, 2017, 19(11): 921-927.
4. 邱贵兴, 裴福兴, 胡侦明, 等. 中国骨质疏松性骨折诊疗指南—骨质疏松性骨折诊断及治疗原则. 黑龙江科学, 2018, 9(2): 85-88, 95.
5. 李宁, 杨明辉, 李新萍, 等. 老年髋部骨折中“骨折联络服务”的初步临床效果. 骨科临床与研究杂志, 2017, 2(5): 287-292.
6. Wong SHJ, Fang XC, Yee KHD, et al. Hip fracture time-to-surgery and mortality revisited: mitigating comorbidity confounding by effect of holidays on surgical timing. Int Orthop, 2018, 42(8): 1789-1794.
7. Majumdar SR, Beaupre LA, Johnston DW, et al. Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study. Med Care, 2006, 44(6): 552-559.
8. Turesson E, Ivarsson K, Thorngren KG, et al. Hip fractures: treatment and functional outcome. The development over 25 years. Injury, 2018, 49(12): 2209-2215.
9. Bohm E, Loucks L, Wittmeier K, et al. Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority. Can J Surg, 2015, 58(4): 257-263.
10. Moja L, Piatti A, Pecoraro V, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190, 000 patients. PLoS One, 2012, 7(10): e46175.
11. Ftouh S, Morga A, Swift C, et al. Guidelines: management of hip fracture in adults: summary of NICE guidance. BMJ, 2011, 342: d3304.
12. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth, 2008, 55(3): 146-154.
13. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA, 2004, 291(14): 1738-1743.
14. Rademakers LM, Vainas T, van Zutphen SW, et al. Pressure ulcers and prolonged hospital stay in hip fracture patients affected by time-to-surgery. Eur J Trauma Emerg Surg, 2007, 33(3): 238-244.
15. HIP ATTACK Investigators. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet, 2020, 395(10225): 698-708.
16. Greve K, Modig K, Talbäck M, et al. No association between waiting time to surgery and mortality for healthier patients with hip fracture: a nationwide Swedish cohort of 59, 675 patients. Acta Orthop, 2020, 91(4): 396-400.
17. Orosz GM, Hannan EL, Magaziner J, et al. Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc, 2002, 50(8): 1336-1340.
18. Larsson G, Strömberg RU, Rogmark C, et al. Prehospital fast track care for patients with hip fracture: impact on time to surgery, hospital stay, post-operative complications and mortality a randomised, controlled trial. Injury, 2016, 47(4): 881-886.
19. Schermann H, Gurel R, Rotman D, et al. Regulatory measures expedited hip fracture surgery without lowering overall patient mortality. J Am Geriatr Soc, 2019, 67(4): 777-783.
20. Dinah AF. Reduction of waiting times in A& E following introduction of “fast-track” scheme for elderly patients with hip fractures. Injury, 2003, 34(11): 839-841.
21. 杨明辉, 吴新宝, 龚晓峰, 等. 骨科与老年科共管模式治疗老年髋部骨折及与英国的比较. 中国骨与关节杂志, 2017, 6(3): 169-173.
22. Chacko AT, Ramirez MA, Ramappa AJ, et al. Does late night hip surgery affect outcome?. J Trauma, 2011, 71(2): 447-453.
23. Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med, 2001, 345(9): 663-668.
24. Kent SJ, Adie S, Stackpool G. Morbidity and in-hospital mortality after hip fracture surgery on weekends versus weekdays. J Orthop Surg (Hong Kong), 2016, 24(1): 41-44.
25. Foss NB, Kehlet H. Short-term mortality in hip fracture patients admitted during weekends and holidays. Br J Anaesth, 2006, 96(4): 450-454.
26. Rashid RH, Zubairi AJ, Slote MU, et al. Hip fracture surgery: does time of the day matter? A case-controlled study. Int J Surg, 2013, 11(9): 923-925.
27. Taylor M, Hopman W, Yach J. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room. Can J Surg, 2016, 59(5): 337-341.
28. Sheikh HQ, Aqil A, Hossain FS, et al. There is no weekend effect in hip fracture surgery. A comprehensive analysis of outcomes. Surgeon, 2018, 16(5): 259-264.
29. Nijland L, Karres J, Simons AE, et al. The weekend effect for hip fracture surgery. Injury, 2017, 48(7): 1536-1541.
30. Asheim A, Nilsen SM, Toch-Marquardt M, et al. Time of admission and mortality after hip fracture: a detailed look at the weekend effect in a nationwide study of 55, 211 hip fracture patients in Norway. Acta Orthop, 2018, 89(6): 610-614.
31. Lewis PM, Waddell JP. When is the ideal time to operate on a patient with a fracture of the hip? A review of the available literature. Bone Joint J, 2016, 98-B(12): 1573-1581.
32. Yonezawa T, Yamazaki K, Atsumi T, et al. Influence of the timing of surgery on mortality and activity of hip fracture in elderly patients. J Orthop Sci, 2009, 14(5): 566-573.
33. Öztürk B, Johnsen SP, Röck ND, et al. Impact of comorbidity on the association between surgery delay and mortality in hip fracture patients: a Danish nationwide cohort study. Injury, 2019, 50(2): 424-431.
34. Mitchell SM, Chung AS, Walker JB, et al. Delay in hip fracture surgery prolongs postoperative hospital length of stay but does not adversely affect outcomes at 30 Days. J Orthop Trauma, 2018, 32(12): 629-633.
35. Lawrence JE, Fountain DM, Cundall-Curry DJ, et al. Do patients taking warfarin experience delays to theatre, longer hospital stay, and poorer survival after hip fracture?. Clin Orthop Relat Res, 2017, 475(1): 273-279.
36. Zehir S, Zehir R, Sarak T. Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy. Acta Orthop Traumatol Turc, 2015, 49(3): 249-254.
37. Tan C, Saito N, Miyawaki I, et al. Preoperative circadian physical activity rhythm and postoperative delirium in cardiovascular surgery patients. Chronobiol Int, 2020, 37(7): 1059-1066.
38. Vasta S, Papalia R, Torre G, et al. The influence of preoperative physical activity on postoperative outcomes of knee and hip arthroplasty surgery in the elderly: a systematic review. J Clin Med, 2020, 9(4): 969.
39. Nilsson H, Angerås U, Bock D, et al. Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer. BMJ Open, 2016, 6(1): e007997.
40. Pouwels S, Fiddelaers J, Teijink JA, et al. Preoperative exercise therapy in lung surgery patients: a systematic review. Respir Med, 2015, 109(12): 1495-1504.
41. Valkenet K, van de Port IG, Dronkers JJ, et al. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil, 2011, 25(2): 99-111.
42. 刘佳鑫, 陈力, 段鑫, 等. 术前早期下地活动对老年髋部骨折患者术后生活自理能力的影响. 中国修复重建外科杂志, 2019, 33(3): 318-322.
43. Magaziner J, Mangione KK, Orwig D, et al. Effect of a multicomponent home-based physical therapy intervention on ambulation after hip fracture in older adults: the CAP randomized clinical trial. JAMA, 2019, 322(10): 946-956.
44. Cheung WH, Shen WY, Dai DL, et al. Evaluation of a multidisciplinary rehabilitation programme for elderly patients with hip fracture: a prospective cohort study. J Rehabil Med, 2018, 50(3): 285-291.
45. Host HH, Sinacore DR, Bohnert KL, et al. Training-induced strength and functional adaptations after hip fracture. Phys Ther, 2007, 87(3): 292-303.
46. Binder EF, Brown M, Sinacore DR, et al. Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA, 2004, 292(7): 837-846.
47. Mangione KK, Craik RL, Tomlinson SS, et al. Can elderly patients who have had a hip fracture perform moderate- to high-intensity exercise at home?. Phys Ther, 2005, 85(8): 727-739.
48. 龙也, 李浪, 王通, 等. 老年转子间骨折术后早期功能锻炼的效果研究. 华西医学, 2018, 33(9): 1124-1127.
49. Milte R, Miller MD, Crotty M, et al. Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture. J Rehabil Med, 2016, 48(4): 378-385.

West China Medical Journal

Timing of surgery and exercise training of hip fracture in the elderly

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