Background and Goal of Study: Hip fracture is a common trauma for elder patients. Postoperative agitation or hyperactive delirium is one of the main concerns after hip surgery and induces a negative outcome. In addition, early postoperative rehabilitation is also a big issue after surgery. We hypothesized that early decision to hip fracture repair from hospital admission would influence the postoperative agitation and standing rehabilitation.
Materials and Methods: This research was a retrospective chart review with the approval of the institutional review board. We examined 600 patients aged 50 years and older underwent hip fracture repair between January 2012 and November 2016. We collected the data of postoperative agitation (defined as Richmond Agitation-Sedation Scale +1 to +4) and the postoperative hours of starting gait training (defined as bedside standing and walking with or without physiotherapists' help except caused by agitation). The patients were divided to two groups; early group (Group E) spent the stand-by time within 24 hours from hospital admission to operation theatre admission, and delayed group (Group D) spent more than 24 hours. To compensate for the differences in patient characteristics, we used a propensity score matching analysis, and comparable patients, 295 patients from each group, were identified for final analysis. The same analysis was also provided when the stand-by time was within or more than 48 hours.
Results and Discussion: There were no statistical difference in postoperative agitation during patients groups (Group E versus Group D: n=72 versus n=84, 95% confidence interval: 0.54 to 1.16, odds ration 0.80, p=0.29). Postoperative possibility of gait training after hip fracture repair was significantly higher in patients in Group E (Group E versus Group D: n= 234 versus n=202 respectively, 95% CI: 1.2 to 2.6, odds ratio 1.8, p=0.003). There was no statistical difference in the same outcomes when the threshold of stand-by time was 48 hours.
Conclusion: Our results suggest that preoperative shortage of stand-time could not make a reduction to the postoperative agitation however we could have a chance to produce the postoperative early gait training, which might contribute to the early rehabilitation and self-reliant life.

The relationships between the stand-by time within 24 hours for hip fracture repair and postoperative agitation or early gait training: a propensity score analysis