The study of the correlation between the waiting day before surgery and the walking ability with a 4-leg-walker in bipolar hemiarthroplasty elderly patients

Abstract

Femoral neck fracture is one of the most prevalent problems affecting elderly patients’ quality of life.  In Thailand, presurgical processes in public hospitals may lead to delays, subsequently resulting in long waiting times for surgery, which often exceed the 48 hours post-admission per recommendation by  the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline Summary: Management of Hip Fractures in Older Adults. Since the average waiting duration for hip replacement surgery was 4.95±3.05 days with 45.54% of patients receiving surgery within 3-4 days of admission at Buddhasothorn Hospital, this study aimed to examine whether prolonged waiting duration before bipolar hemiarthroplasty surgery impacts the patient’s outcome in terms of walking ability with a 4-leg-walker before discharge from the hospital and length of stay post-surgery (LOS). Retrospective analysis of the data registry of 112 patients at Buddhasothorn Hospital between 2017-2022 suggested that bipolar hemiarthroplasty delayed by up to 4 days post-admission had walking outcomes and average LOS statistically equivalent to those who had surgery within 2 days post-admission. Although Fisher’s exact test showed proportions of patients who could walk before hospital discharge were similar, Log-Rank analysis suggests 1.65-fold of patients who had surgery ≤4 days could walk with a gait aid before hospital discharge compared to patients who had surgery after 4 days (p=0.005). Kruskal-Wallis test and Dunn’s post-hoc test revealed that LOS of groups that had surgery within ≤2 days, day 3-4, and ≤4 days showed no significant differences with the mean±SD of 6.61±3.13, 6.67±3.24, and 6.65±3.19 days, respectively. However, delays of more than 4 days post-admission led to a significant increase in average LOS of 8.40±3.46 compared to groups that had surgery within ≤4 days (p=0.015). Furthermore, Log-Rank hazard ratio analysis of relationships between ≤4 days and over >4 days pre-surgery waiting period showed 1.56-fold faster recovery of walking ability with gait aid (p=0.043) and reduced LOS by 1.57-fold (p=0.037). These findings provided data suggesting that potential delays of more than 4 days post-admission before bipolar hemiarthroplasty adversely affected patient outcomes. Furthermore, delays of up to 4 days post-admission had negligible effects on walking outcomes with favorable LOS and duration to walking, and this extended period may enable physicians to perform necessary investigations to ensure the patient’s safety before proceeding with hip surgery.