Postoperative prognostic factors for inability to walk at 6 weeks after fragility hip fracture surgery: A retrospective cohort study

Fragility hip fractures are highly prevalent among the elderly and are associated with substantial morbidity, disability and increased mortality. The inability to regain ambulation after surgery substantially diminishes quality of life. The identification of factors influencing postoperative ambulatory recovery is essential for optimizing patient outcomes. The present study aimed to identify postoperative prognostic factors associated with the inability to walk at 6 weeks post-surgery in patients with fragility hip fractures. This retrospective cohort study reviewed electronic medical records of patients aged ≥50 years who sustained intertrochanteric, subtrochanteric or femoral neck fractures between October 1, 2018, and September 30, 2023. At 6 weeks postsurgery, patients were categorized as either ambulatory or non-ambulatory. Univariable and multivariable risk ratio (mRR) regression analyses were conducted to identify postoperative prognostic factors associated with ambulatory status. Among 432 patients (72.5% women; age 76.8±9.6 years), 325 (75.2%) regained ambulation at 6 weeks, while 107 (24.8%) remained non-ambulatory. The inability to walk at hospital discharge [mRR, 25.3; 95% confidence interval (CI), 10.02-63.75; P<0.001], postoperative need for oxygen support (mRR, 1.33; 95% CI, 1.01-1.75; P=0.038) and the presence of overall postoperative complications within 6 weeks after discharge (mRR, 1.23; 95% CI, 1.01-2.32; P=0.043) were significant prognostic factors for non-ambulation. In conclusion, the key prognostic factors identified were the inability to walk at hospital discharge, the postoperative need for oxygen support and subacute postoperative complications within 6 weeks after discharge. These findings underscore the importance of early complication detection and management in promoting recovery and improving functional outcomes.