Neck of femur fractures in the elderly: Does every hour to surgery count? (original) (raw)
Related papers
Mortality associated with delay in operation after hip fracture: observational study
BMJ, 2006
Objective To estimate the number of deaths and readmissions associated with delay in operation after femoral fracture. Design Analysis of inpatient hospital episode statistics. Setting NHS hospital trusts in England with at least 100 admissions for fractured neck of femur during the study period. Patients People aged ≥ 65 admitted from home with fractured neck of femur and discharged between April 2001 and March 2004. Main outcome measures In hospital mortality and emergency readmission within 28 days. Results There were 129 522 admissions for fractured neck of femur in 151 trusts with 18 508 deaths in hospital (14.3%). Delay in operation was associated with an increased risk of death in hospital, which was reduced but persisted after adjustment for comorbidity. For all deaths in hospital, the odds ratio for more than one day's delay relative to one day or less was 1.27 (95% confidence interval 1.23 to 1.32) after adjustment for comorbidity. The proportion with more than two days' delay ranged from 1.1% to 62.4% between trusts. If death rates in patients with at most one day's delay had been repeated throughout all 151 trusts in this study, there would have been an average of 581 (478 to 683) fewer total deaths per year (9.4% of the total). There was little evidence of an association between delay and emergency readmission. Conclusions Delay in operation is associated with an increased risk of death but not readmission after a fractured neck of femur, even with adjustment for comorbidity, and there is wide variation between trusts.
Hip & Pelvis
Although early surgery is recommended, it is unclear what constitutes a delayed surgery and whether the impact of delayed surgery can differ depending on the reason for the delay. Materials and Methods: A total of 269 consecutive hip fracture patients over 50 years of age who underwent surgery were prospectively enrolled. They were divided into two groups: early and delayed (time from reaching the hospital to surgery less than or more than 48 hours). Patients were also categorized as fit or unfit based on anesthetic fitness. One-year mortality was recorded, and regression analyses were performed to assess the impact of delay on mortality. Results: A total of 153 patients (56.9%) had delayed surgery with a mean time to surgery of 87± ±70 hours. A total of 115 patients (42.8%) were considered medically fit to undergo surgery. No difference in one-year mortality was observed between patients with early surgery and those with delayed surgery (P=0.854). However, when assessment of the time to surgery was performed in a continuous manner, mortality increased with prolonged time to surgery, particularly in unfit patients, and higher mortality was observed when the delay exceeded six days (fit: P=0.117; unfit: P=0.035). Conclusion: The effect of delay on mortality was predominantly observed in patients who were not considered medically fit, suggesting that surgical delays might have a greater impact on patients with medical reasons for delay.
PLoS ONE, 2012
Background: To assess the relationship between surgical delay and mortality in elderly patients with hip fracture. Systematic review and meta-analysis of retrospective and prospective studies published from 1948 to 2011. Medline (from 1948), Embase (from 1974) and CINAHL (from 1982), and the Cochrane Library. Odds ratios (OR) and 95% confidence intervals for each study were extracted and pooled with a random effects model. Heterogeneity, publication bias, Bayesian analysis, and meta-regression analyses were done. Criteria for inclusion were retro-and prospective elderly population studies, patients with operated hip fractures, indication of timing of surgery and survival status. Methodology/Principal Findings: There were 35 independent studies, with 191,873 participants and 34,448 deaths. The majority considered a cutoff between 24 and 48 hours. Early hip surgery was associated with a lower risk of death (pooled odds ratio (OR) 0.74, 95% confidence interval (CI) 0.67 to 0.81; P,0.000) and pressure sores (0.48, 95% CI 0.38 to 0.60; P,0.000). Meta-analysis of the adjusted prospective studies gave similar results. The Bayesian probability predicted that about 20% of future studies might find that early surgery is not beneficial for decreasing mortality. None of the confounders (e.g. age, sex, data source, baseline risk, cutoff points, study location, quality and year) explained the differences between studies. Conclusions/Significance: Surgical delay is associated with a significant increase in the risk of death and pressure sores. Conservative timing strategies should be avoided. Orthopaedic surgery services should ensure the majority of patients are operated within one or two days.
British Medical Journal, 2006
Objective To estimate the number of deaths and readmissions associated with delay in operation after femoral fracture. Design Analysis of inpatient hospital episode statistics. Setting NHS hospital trusts in England with at least 100 admissions for fractured neck of femur during the study period. Patients People aged ≥ 65 admitted from home with fractured neck of femur and discharged between April 2001 and March 2004. Main outcome measures In hospital mortality and emergency readmission within 28 days. Results There were 129 522 admissions for fractured neck of femur in 151 trusts with 18 508 deaths in hospital (14.3%). Delay in operation was associated with an increased risk of death in hospital, which was reduced but persisted after adjustment for comorbidity. For all deaths in hospital, the odds ratio for more than one day's delay relative to one day or less was 1.27 (95% confidence interval 1.23 to 1.32) after adjustment for comorbidity. The proportion with more than two days' delay ranged from 1.1% to 62.4% between trusts. If death rates in patients with at most one day's delay had been repeated throughout all 151 trusts in this study, there would have been an average of 581 (478 to 683) fewer total deaths per year (9.4% of the total). There was little evidence of an association between delay and emergency readmission. Conclusions Delay in operation is associated with an increased risk of death but not readmission after a fractured neck of femur, even with adjustment for comorbidity, and there is wide variation between trusts.
Journal of Orthopaedics and Traumatology, 2015
Background The UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality. Materials and methods Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated. Results A total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06-1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypoand normonatraemic patients [v 2 (1, N = 512) = 0.10, p = 0.757]. Conclusions Hip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable.
Importance of Surgical Delay on Mortality in Patients with Hip Fracture: Mini-Review
Biomedical Journal of Scientific & Technical Research
Introduction: Osteoporotic hip fractures are important health problems in geriatric patients. The mortality rate can reach 10% during admission in hospital and 30% after 12 months. A meta-analysis of 35 independent studies described greater survival among patients who underwent early surgery. Nevertheless, controversy remains about the acceptable waiting time for surgery. The objective of this study is to describe the new knowledge on the relationship between surgical delay and mortality. Methods: The present review was carried out by conducting an electronic search in OVID (Medline and Embase) on hip fracture, mortality and surgical delay. The search was limited to publications in the last 5 years and in English and Spanish. A total of 73 articles were obtained, of which 14 were finally selected. Results: Papers can be grouped into those that fund or not a relationship between surgical delay and mortality. Among the first, different authors described a strong association between mortality and complexity measured by a comorbidities index (Charlson Comorbidity Index or American Society of Anaesthesiologists' score). On the other hand, more studies have shown a strong association between time to surgery and mortality. A study among 42,230 patients used time as a continuous variable showing that wait time was associated with a greater risk of 30day mortality and other complications. Conclusion: Surgical delay is clearly linked to mortality risk in the different cut-points studied. Elderly patients admitted at hospital with hip fracture might be operated in the first 24 hours if the clinical conditions allow the surgery process.
Mortality effects of timing alternatives for hip fracture surgery
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2018
The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay. We obtained discharge abstracts from the Canadian Institute for Health Information for hip fracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram. Of 139 119 medically stable patients with hip fracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on...
The Timing of Hip Fracture Surgery and Mortality Within 1 Year
Orthopaedic Nursing, 2011
rather due to comorbidities complicating the surgical recovery. In prospective studies by Orosz et al. (2004) and Siegmeth, Gurusamy, and Parker (2005), the survival rate for patients who had surgery within 24 to 48 hr was greater than that for patients whose surgery was delayed more than 48 hr. However when, adjusting for patients' factors, such as age, gender, comorbidities, prefracture residence, and prefracture functional status, these authors concluded that mortality was caused by the medical problems that required a late surgery. The prolonged surgical delay did not increase the mortality itself. On the contrary, Shiga, Wajima, and Ohe (2008) systematically reviewed the literature and performed a meta-analysis, using published English-language reports that examined the effect of surgical delay on mortality in patients who underwent hip surgery. They concluded that operative delay beyond 48 hr after admission may increase the odds of a 30-day and a 1-year all-cause mortality significantly.
High volumes of recent surgical admissions, time to surgery, and 60-day mortality
The Bone & Joint Journal, 2021
Aims Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. Methods This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. Results Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Ove...
There is no weekend effect in hip fracture surgery – A comprehensive analysis of outcomes
The Surgeon, 2018
Background: Previous studies have shown that some patient groups suffer adverse outcomes if they are acutely admitted to hospital over a weekend. We aimed to investigate this 'weekend effect' at our centre in patients presenting with a hip fracture. Methods: Consecutive patients undergoing acute hip fracture surgery were identified from a prospective database. Patient demographics, co-morbidities, fracture type, admission blood parameters were examined. Outcomes analysed included 30-day, 90-day and 1-year mortality as well as length of stay, re-operations and delay to surgery. The data were analysed with regards to day of admission and day of surgery separately. Results: A total of 1326 patients were included, of which 368 patients were admitted over a weekend and 411 patients had their operation over a weekend. Overall 30-day mortality was 7.6% (101 patients), whilst the 90-day and 1-year mortalities were 15.3% and 26.8% (203 and 356 patients). There were no significant differences in any of the outcomes based on the day of admission or the day of surgery. Multivariate analysis for 30-day mortality demonstrated the following variables to be significant predictors: admission urea levels (hazard ratio (HR) 1.042, p ¼ 0.027), age (HR 1.058, p < 0.001), admission source (HR 1.428, p < 0.001), surgical delay >48 h (HR 1.853, p ¼ 0.004), male gender (HR 1.967, p ¼ 0.003), previous stroke (HR 2.261, p ¼ 0.038), acute chest infection (4.240, p < 0.001) and chronic liver disease (HR 4.581, p ¼ 0.014). Conclusion: This data suggests that there is no significant weekend effect in hip fracture surgery and mortality is affected by patient co-morbidities and delay to surgery.