title: Factors Associated With Early Functional Outcome After Hip Fracture Surgery.
abstract: BACKGROUND
  Hip fractures are common in the elderly and are likely to become more prevalent as the US population ages. Early functional status is an indicator of longer term outcome, yet in-hospital predictors of functional recovery, particularly time of surgery and composition of support staff, after hip fracture surgery have not been well studied.
  
  
  METHODS
  Ninety-nine consecutive patients underwent hip fracture surgery by a single surgeon between 2009 and 2013. Surgery after 48 hours was deemed as surgical delay, and surgery after 5 pm was deemed as after hours. Surgical support staff experience was determined by experts from our institution as well as documented level of training. Functional status was determined by independent ambulation on postoperative day (POD) 3.
  
  
  RESULTS
  On POD3, 48 (79%) of 62 patients with no delay were able to ambulate, whereas only 14 (38%) of 37 patients with delayed surgery were able to ambulate (P < .001). This relationship persisted when adjusted for American Society of Anesthesiologist classification. No delay in patients older than 80 (odds ratio [OR], 6.91; 95% confidence interval [CI], 2.16-22.10) and females (OR, 7.05; 95% CI, 2.34-21.20) was associated with greater chance of early ambulation. After-hours surgery was not associated with ambulation (P = .35). Anesthesiologist and circulating nurse experience had no impact on patient's ambulatory status; however, nonorthopedic scrub technicians were associated with worse functional status (OR 7.50; 95% CI, 1.46-38.44, P = .01).
  
  
  CONCLUSIONS
  Surgical delay and nonorthopedic scrub technicians are associated with worse early functional outcome after hip fracture surgery. Surgical delay should be avoided in older patients and women. More work should be done to understand the impact of surgical team composition on outcome.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cohn
authors.affiliation: Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Guang-Ting
authors.initials: GT
authors.lastname: Cong
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Minda L
authors.initials: ML
authors.lastname: Patt
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Pingal
authors.initials: P
authors.lastname: Desai
authors.affiliation: Hospital for Special Surgery, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Lester
authors.initials: L
authors.lastname: Zambrana
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Lane
keywords: geriatric trauma; rehabilitation; time to surgery; trauma surgery