Journal des soins infirmiers et des soins

Nursing Care after Hip Fracture Surgery Predicts Patient Ambulatory Ability at 3 Months after Surgery

Abstract

Akiko Kondo, Keiko Sada, Chikae Yamaguchi and Etsuko Fujimoto

Purpose: This study examines whether nursing care predicts the incidence of complications, mortality, ambulatory ability at discharge and 3 months after surgery or the length of stay for patients who have undergone hip fracture surgery.

Methods: This is a retrospective observational study conducted at a community general hospital in Japan. Participants were patients who were 65 years or older and who had hip fracture surgery during the study period, April 2007 to March 2011. Data on demographics, treatments, nursing care and health outcomes during the hospital stay were collected from hospital records. A questionnaire regarding the patient’s health outcomes after discharge was sent to patients and/or family members.

Results: In all, 449 patients met the inclusion criteria. The average age was 81.9 years, and 79.0% were female. In total, 94.4% of the patients were recorded as having obtained nursing care for getting out of bed, and 47.7% were recorded as having obtained nursing care for bearing weight. Nursing care associated with the topic “tell patients the necessity of getting out of bed early or encourage patients to get out of bed” were significantly related to a lower incidence of complication (OR=0.341, P=0.017). Patients with recorded nursing care for weight bearing had significantly greater ambulatory ability at discharge after adjusting for the introduction of the fixed-payment system, patient characteristics, type of surgery, hours of physical therapy and length of stay before surgery (OR=1.890, P=0.006). Patients with recorded nursing care for weight bearing had significantly greater ambulatory ability at 3 months after adjusting for the same covariates (OR=2.175, P=0.008).

Conclusion: Nursing care soon after surgery in an acute care hospital can improve the long-term outcomes of patients after they undergo hip fracture surgery. In addition to physical therapists, nurses should more willingly engage in the rehabilitation of patients in the orthopedic wards.