The impact of postoperative pain on early ambulation after hip fracture.

Hip fractures are the most serious consequence of falling in older people with osteoporosis. Early ambulation is one of the main goals of inpatient rehabilitation aimed at reducing negative effects of immobilization, and promoting functional recovery. Recognizing the role of different factors that are associated with time to ambulation time after hip fracture surgery may help decrease morbidity and mortality rates. The aim of this study was to examine the impact of postoperative pain time to ambulation following hip fracture surgery. A total of 96 patients who consecutively presented at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia during a 6 month period were included in the study. Subjects were assessed regarding socioedemographic characteristics, prefracture functional status, cognitive status, general health status, fracture type, type of anaesthesia, and waiting time for surgery. The VAS scale (0-100) was used to measure pain intensity on the first postoperative day. Our results revealed that patients, whose time to ambulation was = 48 h postoperatively were of worse physical health, and had significantly higher VAS score on the first postoperative day. Unrelieved pain in geriatric hip fracture patients is associated with delayed ambulation. Future research should confirm the posi-tive effects of aggressive pain management programs on early functional outcome in elderly patients who sustain hip fractures.

[Functional status of patients after surgical myocardial revascularization].

UNLABELLED: Determination of patient's functional status in early postoperative period is a delicate task, because of its general health status. Measures that can be used for that purpose are walk tests and functional status questionnaires. OBJECTIVE: To determine correlation of different functional tests administered preoperatively and two minute walk test (2MWT) done postoperatively. To detect predictors of early functional recovery measured with two minute walk test. METHOD: We examined ninety eight patients hospitalized for an elective coronary artery bypass graft surgery in February and March 2008. Functional status was assessed preoperatively using Duke Activity Status Index questionnaire (DASI), generic health related quality of life questionnaire and two minute walk test. Prior to discharge from the hospital, two minute walk test was repeated along with VAS for intensity of pain. Statistical analyze was done using Pearson's correlation coefficient, T test and multivariate regression analysis. RESULTS: Distance walked in 2 minutes decreased significantly postoperatively (p < 0.001). There was significant correlation between DASI and SF -12 preoperatively (r = 0.6 p < 0.001) and DASI preoperatively with 2MWT postoperatively (r = 0.4 p < 0.001). 2MWT postoperatively showed good correlation with intensity of pain (r = -0.42 p < 0.001) and age (r = -0.35 p < 0.001). There were no significant correlation with comorbidity, number of bypasses or postoperative complications. Multivariate regression analysis showed that the age was the strongest independent predictor of functional recovery (beta = - 0.33 < 0.05p) and that values of DASI preoperatively had moderate importance in prediction of functional status(beta = 0.238 p < 0.06). CONCLUSION: 2MWT was sensitive to change postoperatively. Significant correlation of 2MWT postoperatively with DASI preoperatively, age and VAS, as well as prediction capacity of age and DASI, gives us possibility to utilize those parameters in early rehabilitation program in order to achieve maximal functional recovery of patients.