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Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score

Department of Anaesthesiology, Hvidovre University Hospital, Copenhagen DK-2650, Denmark; nbf{at}comxnet.dk

Morten T Kristensen

Department of Physiotherapy, Hvidovre University Hospital, Denmark and Section of Surgical Pathophysiology, Juliane Marie Centre 4074, Rigshospitalet, Denmark

Henrik Kehlet

Section of Surgical Pathophysiology, Juliane Marie Centre 4074, Rigshospitalet, Denmark

Objective: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients.

Design: Prospective, descriptive study.

Setting: An orthopaedic hip fracture unit in a university hospital.

Patients: Four hundred and twenty-six consecutive hip fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria.

Main outcome measure: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental score for cognitive dysfunction were performed. On the first three postoperative days patients were assessed with the cumulated ambulation score consisting of a cumulated assessment of simple ambulation characteristics with a score from 0 to18 (fully mobile). The three assessments were correlated to short-term outcome parameters.

Results: The cumulated ambulation score was a highly significant predictor for length of hospitalization, time to discharge status, 30-day mortality and postoperative medical complications (P < 0.001 for all). The cumulated ambulation score was superior in its association with all postoperative outcome parameters to both the New Mobility Score and the mental score. A cumulated ambulation score of ±10 correlated with a 99% survival at one month and 93% discharge to own home.

Conclusion: The cumulated ambulation score is a potentially valuable score for early prediction of short-term postoperative outcome after hip fracture surgery.

Clinical Rehabilitation, Vol. 20, No. 8, 701-708 (2006)
DOI: 10.1191/0269215506cre987oa


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