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.

Li-Heng Li, Hao Guo, Li-Na Chen, Yi Wei, Yu-Bo Xie

Abstract readObservational Study

In one paragraph

Observational study in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Li-Heng Li *Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6, Shuangyong Road, Nanning City, Guangxi Province, 530021, China.

Hao Guo *Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China.

Li-Na ChenDepartment of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6, Shuangyong Road, Nanning City, Guangxi Province, 530021, China.

Yi WeiDepartment of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6, Shuangyong Road, Nanning City, Guangxi Province, 530021, China. 46601146@qq.com.

Yu-Bo XieDepartment of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, China. xybdoctor@163.com.

Funding

Guangxi Key Research and Development Program AB24010066Guangxi Science and Technology Base and Talent Special Project AD25069060

6 · The paper itself

Abstract

objectiveThis 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.

methodsThis 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.

resultsAmong 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.

conclusionAfternoon 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.

Indexed as

Arthroplasty, Replacement, HipArthroplasty, Replacement, KneePostoperative ComplicationsSleep Wake DisordersWalkingAgedAged, 80 and overCohort StudiesFemaleHumansMaleProspective StudiesSecondary Data AnalysisTime FactorsJoint replacement surgeryOlder adult patientsPostoperative functional recoveryPostoperative sleep disorderSurgical timing

Identifiers

PMID42477602

DOI10.1186/s12877-026-08015-3

PMCPMC13595692

What Socratic holds

Textmetadata

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.