Functional recovery and rehabilitation efficiency after elective versus urgent trauma-related orthopedic surgery in older adults: a retrospective cohort study

This retrospective cohort study compared functional recovery and rehabilitation efficiency among older adults undergoing inpatient geriatric-orthopedic rehabilitation following elective versus urgent trauma-related orthopedic surgery and examined independent predictors of total Functional Independence Measure (FIM) gain. The sample included 563 adults aged greater than or equal to 65 years (elective surgery, n = 219; urgent surgery, n = 344) admitted to a government-funded geriatric rehabilitation hospital, all of whom received standardized multidisciplinary rehabilitation. Functional status was assessed at admission and discharge using the FIM. Outcomes included total FIM gain, motor FIM gain, cognitive FIM gain, and rehabilitation efficiency (functional gain per day). Multivariable regression models adjusted for age, sex, comorbidity burden, admission FIM, and length of stay. Patients in the group were older and had significantly lower admission FIM scores (P < 0.001). Both groups demonstrated significant improvements in total, motor, and cognitive FIM scores during rehabilitation (P < 0.001). Although discharge FIM scores remained lower among urgent-surgery patients, total FIM gain did not differ between groups. Motor rehabilitation efficiency was higher in the elective-surgery group (0.83 versus 0.70 points/day; P = 0.025), and admission FIM emerged as the strongest independent predictor of total FIM gain. These findings suggest that older adults may achieve meaningful functional recovery during inpatient orthopedic rehabilitation regardless of surgical pathway and support consideration of equitable access to intensive post-acute rehabilitation services.