2026 年 29 巻 1 号 p. 31-41
Objectives: The impact of rehabilitation (RH) started on postoperative day 0 (Day 0) and the association between intensive RH and time to home discharge after hip fracture surgery remain unclear. We aimed to investigate the influence of the RH starting date and RH provision volume on time to home discharge. Methods: Using the Diagnosis Procedure Combination database, we retrospectively analyzed patients who underwent surgery within 7 days of admission between April 2020 and March 2022. RH starting date was classified as Day 0, postoperative day 1 (Day 1), postoperative day 2 (Day 2), or postoperative day 3 or later (≥Day 3). RH provision volume was calculated as the average number of daily RH units. Time to home discharge was used as the outcome, with home discharge as the event occurrence. Cox proportional hazards regression models were used to examine these associations. Results: A total of 207450 patients were included. Both variables had a statistically significant association with time to home discharge. The adjusted hazard ratio based on RH started on ≥Day 3 was 0.97 (95% confidence interval: 0.93–1.02) for Day 2, 1.05 (1.01–1.09) for Day 1, and 1.18 (1.10–1.27) for Day 0. The adjusted hazard ratio based on the lowest dose (0–1.0 units/day) was 1.12 (1.08–1.15) for 1.1–2.0 units/day, 1.10 (1.06–1.14) for 2.1–3.0 units/day, 1.04 (1.00–1.08) for 3.1–4.0 units/day, 1.09 (1.04–1.14) for 4.1–5.0 units/day, and 1.11 (1.06–1.17) for ≥5.1 units/day. Conclusions: Starting RH on Day 0 was suggested to potentially facilitate faster or easier home discharge. Additionally, providing at least one unit of RH appears effective.
