# The Association Between Preoperative Mobility and 1-Year Survival Following Hip Fracture Surgery: A Nationwide Population Study

## TL;DR

This study shows that lower preoperative mobility in hip fracture patients is linked to higher 1-year mortality and a weaker postoperative recovery.

## Contribution

The study provides new evidence that preoperative mobility is an independent predictor of 1-year mortality after hip fracture surgery.

## Key findings

- Patients with no preoperative mobility had an 86% higher risk of death within one year after surgery.
- There is a moderate positive correlation between pre- and postoperative mobility (ρ = 0.49).

## Abstract

Background/Objectives: Decreased preoperative mobility increases the risk of decline and postoperative mortality in a frail patient with a hip fracture. This study investigates the correlation between preoperative mobility and 1-year mortality and between pre- and postoperative mobility. Methods: This retrospective, national cohort study used data from the Dutch Hip Fracture Audit (2018–2023). Excluded patients were those with an indication for a total hip arthroplasty, non-surgical treatment or missing data on mortality or preoperative mobility. Mobility was determined by the Fracture Mobility Score (FMS). A Cox proportional-hazards regression model assessed the correlation between FMS and mortality by using hazard ratios with 95% confidence intervals. A subgroup analysis was conducted for patients whose data on postoperative mobility was complete. Spearman’s test was used to assess the correlation between pre- and postoperative mobility. A p-value < 0.05 was considered statistically significant in both analyses. Results: A total of 77,185 patients were included in the study. A Cox regression model shows a stepwise increase in risk of death with a lower preoperative FMS, after correction of confounders. Those with no functional mobility showed the highest risk of death within 1 year after surgery (HR 1.86, 95% CI 1.65–2.09, p < 0.001). Spearman’s correlation demonstrated a moderate positive correlation between pre- and postoperative mobility, which is demonstrated by ρ = 0.49 (p < 0.001). Conclusions: Preoperative mobility seems to be an independent predictor of 1-year mortality. Additionally, this study demonstrated a moderate positive correlation between pre- and postoperative mobility.