Title : Cognition, mobilisation and surgical timing after hip fracture: Survival and return home
Abstract:
Background: Hip-fracture outcomes reflect patient frailty and multiple care-pathway factors. We examined the relative links of cognition, mobilisation, surgical timing and OrthoGeriatric (OG) review with survival, hospital stay and return home.
Methods: We analysed 1,805 hip-fracture patients recorded from 2021–2025 in a single-centre service dataset. The primary functional outcome was discharge to own home among patients admitted from home. Secondary outcomes were hospital stay and recorded 30-day and cumulative 1-year death rate. We used adjusted models to take account of age, sex, ASA grade, delay to surgery >36 hours, OrthoGeriatric (OG) assessment within 48 hours, mobilisation and year. Cognition (AMTS/4AT) was available from 2023–2025 and examined in sensitivity models.
Results: Median age was 85 years (IQR 78–91); 1,225/1,766 (69.4%) patients with recorded sex were female. Median time to surgery was 33.5 hours (IQR 21.0–49.0), and 796/1,713 (46.5%) waited >36 hours. Among previously home-dwelling patients with known discharge destination, 1,123/1,485 (75.6%) returned home. Those recorded as mobilised returned home more often than those not mobilised (81.7% vs 61.5%) and had shorter median hospital stay (17 vs 22 days). In the 2022–2025 adjusted model, mobilisation was linked with greater odds of return home (OR 2.70, 95% CI 1.90–3.82) and shorter hospital stay (ratio 0.82, 95% CI 0.75–0.90); delay to surgery >36 hours was linked with longer hospital stay (ratio 1.22, 95% CI 1.13–1.31), while orthogeriatric (OG) assessment within 48 hours was linked with shorter hospital stay (ratio 0.90, 95% CI 0.83–0.99). In 2023–2025, cognitive problems were still linked with lower odds of return home (OR 0.25, 95% CI 0.17–0.38) and higher 30-day death rate (OR 3.90, 95% CI 2.28–6.66). Recorded 30-day death rate was 7.7% overall.
Conclusions: Mobilisation was the care-pathway factor most strongly linked with returning home, whereas delay to surgery was more consistently linked with prolonged hospital stay. Cognitive problems marked a high-risk group for death and failure to return home. These findings support a multidimensional OrthoGeriatric (OG) model focused on cognition, timely surgery and postoperative mobilisation rather than any single performance target.
Keywords: hip fracture, orthogeriatric care, cognition, mobilisation, time to surgery, death rate, discharge destination, hospital stay
