Factors Predicting Ambulatory Status at Discharge After Fragility Hip Fracture Surgery: A Retrospective Cohort Study

<b>Background</b>/<b>Objectives</b>: Ambulatory status at hospital discharge contributes to subsequent functional recovery in older adults following hip fracture. This study aimed to identify independent predictors of ambulatory status at hospital discharge following surgery for fragility hip fractures in a tertiary care setting in Southern Thailand. <b>Methods</b>: A retrospective study was conducted among patients aged 50 years and older who underwent surgery for low-energy hip fractures between 1 October 2018, and 30 September 2023. Data on preoperative, intraoperative, postoperative, and process of care factors were collected from electronic medical records. Student's <i>t</i>-tests and chi-square tests compared candidate variables between groups. Univariable and multivariable risk analyses were performed to identify independent predictors of ambulation at discharge. <b>Results</b>: Among 532 patients (72.7% women; mean age 76.8 ± 9.7 years), 314 (59.0%) were ambulatory at hospital discharge. Multivariable analysis demonstrated that achieving rehabilitation at the ambulation training level (mRR = 24.10; 95% CI: 9.14-63.60; <i>p</i> < 0.001) and undergoing hip arthroplasty (mRR = 1.17; 95% CI: 1.07-1.29; <i>p</i> < 0.001) were significant positive predictors of ambulation. Conversely, a history of cerebrovascular disease with hemiplegic sequelae (mRR = 0.70; 95% CI: 0.53-0.91; <i>p</i> < 0.01) and delayed initiation of rehabilitation more than 72 h postoperatively ((mRR = 0.84; 95% CI: 0.73-0.97; <i>p</i> < 0.05) were associated with reduced likelihood of ambulation. <b>Conclusions</b>: Ambulatory status at hospital discharge was strongly associated with early, ambulation-level rehabilitation and hip arthroplasty, whereas history of stroke and delayed rehabilitation reduced mobility. These findings emphasize the importance of timely, targeted rehabilitation to optimize functional recovery after hip fracture surgery.