Article

Causes and effects of surgical delay in patients with hip fracture: a cohort study.

Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Annals of internal medicine (Impact Factor: 16.1). 08/2011; 155(4):226-33. DOI: 10.1059/0003-4819-155-4-201108160-00006
Source: PubMed

ABSTRACT The clinical effect of surgical delay in older patients with hip fracture is controversial. Discrepancies among study findings may be due to confounding that is caused by the reason for the delay or a differential effect on patient risk subgroups.
To assess the effect of surgical delay on hospital outcomes according to the cause of delay.
Prospective cohort study.
A hip fracture unit in a university hospital in Spain.
2250 consecutive elderly patients with hip fracture.
Time to surgery, reasons for surgical delay, adjusted in-hospital death, and risk for complications.
Median time to surgery was 72 hours. Lack of operating room availability (60.7%) and acute medical problems (33.1%) were the main reasons for delays longer than 48 hours. Overall, rates of hospital death and complications were 4.35% and 45.9%, respectively, but were 13.7% and 74.2% in clinically unstable patients. Longer delays were associated with higher mortality rates and rates of medical complications. After adjustment for age, dementia, chronic comorbid conditions, and functionality, this association did not persist for delays of 120 hours or less but did persist for delays longer than 120 hours (P = 0.002 for overall time effect on death and 0.002 for complications). The risks were attenuated after adjustment for the presence of acute medical conditions as the cause of the delay (P = 0.06 for time effect on mortality and 0.31 on medical complications). Risk for urinary tract infection remained elevated (odds ratio, 1.54 [95% CI, 0.99 to 2.44]). No interaction between delay and age, dementia, or functional status was found.
This was a single-center study without postdischarge follow-up.
The reported association between late surgery and higher morbidity and mortality in patients with hip fracture is mostly explained by medical reasons for surgical delay, although some association between very delayed surgery and worse outcomes persists.
None.

3 Bookmarks
 · 
308 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The effect of preoperative wait time for surgery is a long-standing subject of debate. Although there is disagreement among clinicians on whether early surgery confers a survival benefit per se, most reports agree that early surgery improves other outcomes such as length of stay, the incidence of pressure sores, and return to independent living. Therefore, it would seem prudent to surgically treat elderly patients with hip fractures within the first 48 hours of admission. However, the current body of evidence is observational in nature and carries the potential for bias inherent in such analyses. Evidence in the form of a large randomized controlled trial may ultimately be required to fully evaluate the impact of surgical timing on patients with fractures of the hip.
    Geriatric orthopaedic surgery & rehabilitation. 09/2014; 5(3):138-40.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims The purpose of this study was to report a less seen age-group (>90) of hip fractures and to assess the predictors of functional loss, complications and mortality. Methods Thirty-two patients at a mean age of 92.8 (±2.7) were treated in a single institution and reported at a mean follow-up of 2.02 (±1.35) years. Results Mortality was similar between proximal femoral nailing (PFN) and bipolar cemented hemiarthroplasty (BCH) in first year (p = 0.17) but significantly high in following years in BCH (p = 0.035) and patients with cardiac disease (p = 0.054). Conclusion Hip fractures are challenging in extremely old patients and associated with increased mortality and disability.
    Journal of Orthopaedics. 09/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Hospital treatment for hip fracture is complex, often involving sequential episodes for acute orthopaedics, rehabilitation and care of contingent conditions. Most reports of hospital length of stay (LOS) address only the acute phase of care. This study identifies the frequency and mean duration of the component episodes within total hospital stay, and measures the impacts of patient-level and clinical service variables upon both acute phase and total LOS.Methods Administrative datasets for 2552 subjects hospitalised between 1 July 2008 and 30 June 2009 were linked. Associations between LOS, pre-fracture accommodation status, age, sex, fracture type, hospital separation codes, selected comorbidities and complications were examined in regression models for acute phase and total LOS for patients from residential aged care (RAC) and from the community.ResultsMean total LOS was 30.8 days, with 43 per cent attributable to acute fracture management, 37 per cent to rehabilitation and 20 per cent to management of contingent conditions. Community patients had unadjusted total LOS of 35.4 days compared with 18.8 days for RAC patients (p <0.001). The proportion of transfers into rehabilitation (57 per cent vs 17 per cent, p <0.001) was the major determinant for this difference. In multivariate analyses, new RAC placement, discharge to other facilities, and complications of pressure ulcer, urinary or surgical site infections increased LOS by at least four days in one or more phases of hospital stay.Conclusion Pre-fracture residence, selection for rehabilitation, discharge destination and specific complications are key determinants for acute phase and total LOS. Calculating the dimensions of specific determinants for LOS may identify potential efficiencies from targeted interventions such as orthogeriatric care models.
    BMC Health Services Research 01/2015; 15(1):17. · 1.66 Impact Factor