Early mobilization within 24 to 48&#xa0;h improves postoperative clinical outcomes in older adults with hip fracture: A systematic review and meta-analysis.

Chi Kit Ma; Fen Liu; Wing Yan Lam; Pui Yung Li; Tsz Fung Chan; Suk Ying Ho; Wun Yi Chan; Juliet Chigozie Donatus Ezulike; Jed Montayre

doi:10.1016/j.ijnurstu.2026.105654

PubMed · 42600233

Early mobilization within 24 to 48 h improves postoperative clinical outcomes in older adults with hip fracture: A systematic review and meta-analysis.

Chi Kit Ma·Fen Liu·Wing Yan Lam·Pui Yung Li·Tsz Fung Chan·Suk Ying Ho·Wun Yi Chan·Juliet Chigozie Donatus Ezulike·Jed Montayre

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Abstract

BACKGROUND: Hip fracture is a major public health concern among older adults, often resulting in prolonged disability, institutionalization, and increased healthcare burden. Early mobilization has been widely recommended to enhance postoperative recovery; however, there is a lack of consolidated evidence quantifying its impact on clinical and functional outcomes. This study aimed to synthesize and evaluate the impact of early mobilization following hip fracture surgery in older adults and to explore potential sources of heterogeneity to better inform clinical and nursing practice. METHODS: A comprehensive literature search was conducted across seven databases (PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Emcare) from inception to June 15, 2025. Eligible studies included randomized controlled trials and observational cohort studies comparing early mobilization (defined as ambulation within 24 to 48 h postoperatively) to delayed or usual mobilization in patients undergoing hip fracture surgery. Primary outcomes included mortality, discharge destination, and length of hospital stay. Secondary outcomes included postoperative complications, functional recovery, and readmission. Risk of bias was assessed using funnel plots and Egger's test. RESULTS: Twenty-six studies involving 297,435 patients were included. Compared with delayed mobilization, early mobilization significantly reduced 30-day mortality (relative risk = 0.40, 95% confidence interval: 0.25-0.64) and 1-year mortality (relative risk = 0.57, 95% confidence interval: 0.40-0.80) (both p < 0.05). In regional analyses of pooled mortality, similar reductions were observed across Asia-Pacific, North America, and Europe. Patients receiving early mobilization were more likely to be discharged home and had shorter hospital stays. Early mobilization also resulted in a reduced risk of postoperative complications (relative risk = 0.79, 95% confidence interval: 0.74-0.84, p < 0.05), with specific improvements in pneumonia and thromboembolism rates. Functional independence was significantly improved, as shown by higher Barthel Index scores and increased odds of achieving Functional Independence Measure ≥5 at discharge. No significant difference was observed in readmission rates. CONCLUSIONS: lization within 24 to 48 h following hip fracture surgery was associated with favorable outcomes, including reduced mortality, improved functional independence, higher rates of discharge to home, shorter hospital length of stay, and fewer postoperative complications. Although heterogeneity across studies and the predominance of observational evidence warrant cautious interpretation, these findings support current recommendations for early mobilization and highight the potential value of structured and standardized mobilization protocols in routine postoperative hip fracture care.

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Humans Hip Fractures Early Ambulation Aged Postoperative Complications Length of Stay Treatment Outcome Clinical outcomes Early mobilization Hip fracture Meta- analysis Mortality Postoperative complications Systematic review Journal Article Systematic Review Meta-Analysis Review

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Chi Kit Ma, Fen Liu, Wing Yan Lam, Pui Yung Li, Tsz Fung Chan, Suk Ying Ho, Wun Yi Chan, Juliet Chigozie Donatus Ezulike, Jed Montayre. 2026-07-31. Early mobilization within 24 to 48 h improves postoperative clinical outcomes in older adults with hip fracture: A systematic review and meta-analysis.. https://doi.org/10.1016/j.ijnurstu.2026.105654

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Aged subject Clinical outcomes subject Humans subject Journal Article subject Journal Article; Systematic Review; Meta-Analysis; Review resource Length of Stay subject Meta-Analysis subject Mortality subject Systematic reviews study

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