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Introduction
A hip fracture is a fracture occurring between the neck of the femur and the trochanter of the femur. It is a common and serious health condition affecting the elderly patients, and frequently requires surgical intervention and postoperative restricted activity1. Notably, the occurrence of postoperative new-onset constipation is often triggered by changes in traditional defecation habits, comorbid with previous various cardiovascular and cerebrovascular diseases. Postoperative constipation may lead to multiple complications2, such as abdominal distension, intestinal obstruction, postoperative infections and pneumonia. Moreover, prolonged stool retention can lead to fecal impaction, fermentation, and endotoxins, inducing psychological and physiological dysfunction. The difficulty in defecation may induce various adverse cardiovascular and cerebrovascular events3. In addition, family caregivers often face emotional stress and financial strain associated with the need for medical consultations, treatments, and potential lifestyle adjustments. Furthermore, constipation-related medical interventions together with the decreased individual productivity impose a significant economic burden on the society. Generally, constipation imposes a significant suffering on individuals, family burden, and financial stress of the health cost.
Currently, postoperative constipation is primarily treated through consumption of fiber and fluids intake, participation in more physical activities, and seeking medical interventions to soften stools and facilitate bowel movements4. Although these interventions can alleviate postoperative constipation, there is no tool that facilitates the prediction and prevention of postoperative constipation after hip fracture surgery in elder patients. Thus, it prompt us to further investigate risk factors, develop predictive models, and implement early interventions to prevent postoperative constipation. Recent research has identified behavioral barriers and the lack of privacy for defecation in hospital settings as significant risk factors contributing to postoperative constipation following hip fracture surgery5. Another study has been reported that female, elder age, unemployed, pain intensity, opioid intake, and previous constipation are associated with a higher risk of constipation in orthopedic patients6. However, these studies were limited by small sample sizes, comprising only 140 and 150 patients, respectively. In addition, neither study developed a predictive calculator tool to assess the risk of postoperative constipation, highlighting a critical gap in the current research landscape. These limitations underscore the need for larger-scale studies and the development of practical tools to enhance clinical prediction and intervention strategies....