Association of Charlson Comorbidity Index and ASA Score with Postoperative Mobility in Geriatric Hip Fracture Patients

TL;DR

This study finds that older patients with hip fractures do not bear as much weight as recommended after surgery, and their mobility is linked to health scores like CCI and ASA.

Contribution

The study identifies fracture-specific associations between clinical scores (CCI, ASA) and postoperative weight bearing, and highlights the Barthel Index as a potential predictor of mobility.

Findings

Early postoperative weight bearing remains below recommended levels, especially in trochanteric femoral fractures.

Higher CCI values are linked to increased limb loading in trochanteric fractures, while higher ASA scores correlate with reduced loading.

The Barthel Index is independently associated with limb loading and may help identify patients needing physiotherapy.

Abstract

Background: Early mobilization with permission for full weight bearing is a cornerstone of postoperative care after proximal femoral fractures (PFFs). However, its biomechanical implementation during gait remains unclear. Clinical scores such as the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) classification describe comorbidity burden, but their relationship with actual weight bearing and functional outcome regarding activities associated with daily living is insufficiently understood. Methods: In this prospective cohort study, patients aged > 65 years treated surgically for femoral neck fractures (FNFs) or trochanteric femoral fractures (TFFs) were included. Postoperative weight bearing was assessed after 4 to 7 days using sensor-based insoles. Average peak force of the operated limb, normalized to body weight, was the primary outcome. Associations with postoperative weight bearing and functional outcome were analyzed using multivariable linear regression models. Results: Early postoperative weight bearing remained below recommended levels, with lower limb loading in TFFs. Higher CCI values were associated with increased loading in TFF patients, and higher ASA classifications with reduced loading. Higher postoperative Barthel Index (BI) was independently associated with increased limb loading. Postoperative BI was influenced by age, preoperative BI, and fracture type. Conclusions: Despite permission for full weight bearing, early postoperative limb loading after PFF remains below recommended levels, particularly in TFFs. CCI and ASA show fracture type-specific associations with actual weight bearing, whereas BI is independent of ASA and CCI. The BI may serve as a surrogate parameter to identify patients at risk of insufficient limb loading who may benefit from targeted physiotherapeutic interventions.