Abstract
The 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. In this prospective cohort study, 882 patients aged ≥ 65 years from 10 acute hospitals in Japan were divided into early-ambulation (EA) (ambulation initiated on postoperative day 1 or 2) and late-ambulation (LA) (ambulation initiated on postoperative day 3 or later) groups. The Functional Independence Measure (FIM) was assessed 1 day postoperatively, 1 week postoperatively, and at discharge. Independent walking regardless of walking aids was defined as walking FIM ≥ 5. Multivariate logistic regression analysis and a generalized linear mixed model, accounting for inter-hospital variability, determined whether EA affected independent walking at 1 week postoperatively and at discharge. The number of patients walking independently 1 week postoperatively and at discharge was 156 (17.7%) and 292 (33.1%), respectively. On multivariate logistic regression analysis, EA was associated with independent walking at 1 week postoperatively (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.17-4.94; P < 0.0001) and at discharge (OR 3.33; 95% CI 2.38-4.69; P < 0.0001). This study highlights the importance of EA in promoting postoperative independent walking, regardless of hospital setting.