BMC geriatrics · 2026
Association of surgical timing with 30-day independent ambulation and postoperative sleep disorder in older adult patients undergoing joint replacement: an exploratory secondary analysis of a prospective cohort.
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Li Li-Heng, Guo Hao, Chen Li-Na, Wei Yi, Xie Yu-Bo
Аннотация
OBJECTIVE: This exploratory study investigated the observational association between surgical timing (morning versus afternoon) and 30-day independent ambulation in older adult joint replacement patients, and whether postoperative sleep disorder (PSD) mediates this association.
METHODS: This was an exploratory secondary analysis of a prospectively registered cohort. Patients aged ≥ 65 years undergoing joint replacement were included. Surgical timing was the exposure, 30-day independent ambulation the primary outcome, and PSD the potential mediator. Propensity score matching (PSM) was used to balance baseline characteristics, and a doubly robust sensitivity analysis was performed to address residual imbalance. Logistic regression and counterfactual mediation analysis were then conducted.
RESULTS: Among 753 eligible patients, PSM balanced most baseline characteristics. Afternoon surgery was significantly associated with higher odds of 30-day independent ambulation (OR = 2.106, 95% CI: 1.407-3.146, p = 0.001). The Natural Direct Effect remained significant (OR = 2.174, p < 0.001), while the Natural Indirect Effect via PSD was not significant (OR = 0.969, p = 0.654). E-value analysis suggested moderate robustness.
CONCLUSION: Afternoon surgery is associated with better 30-day independent ambulation, and PSD does not mediate this observational association. All findings are exploratory, hypothesis-generating, and require validation in randomized controlled trials.
METHODS: This was an exploratory secondary analysis of a prospectively registered cohort. Patients aged ≥ 65 years undergoing joint replacement were included. Surgical timing was the exposure, 30-day independent ambulation the primary outcome, and PSD the potential mediator. Propensity score matching (PSM) was used to balance baseline characteristics, and a doubly robust sensitivity analysis was performed to address residual imbalance. Logistic regression and counterfactual mediation analysis were then conducted.
RESULTS: Among 753 eligible patients, PSM balanced most baseline characteristics. Afternoon surgery was significantly associated with higher odds of 30-day independent ambulation (OR = 2.106, 95% CI: 1.407-3.146, p = 0.001). The Natural Direct Effect remained significant (OR = 2.174, p < 0.001), while the Natural Indirect Effect via PSD was not significant (OR = 0.969, p = 0.654). E-value analysis suggested moderate robustness.
CONCLUSION: Afternoon surgery is associated with better 30-day independent ambulation, and PSD does not mediate this observational association. All findings are exploratory, hypothesis-generating, and require validation in randomized controlled trials.