Article

Morbidity and mortality after hip fracture: the impact of operative delay.

Ashkelon District Health Office, Barzilai Medical Center, Ashkelon, Israel.
Archives of Orthopaedic and Trauma Surgery (impact factor: 1.37). 07/2004; 124(5):334-40. DOI:10.1007/s00402-004-0662-9 pp.334-40
Source: PubMed

ABSTRACT The relationship between the timing of surgery after hip fracture and the subsequent survival of the patient has been studied extensively, yet still remains a controversy. This study aims to assess the impact of operative delay on the 1-year survival of patients and on the rate of complications during the postoperative hospital stay.
Medical and demographic data were extracted from the hospital records of 651 consecutive hip fracture patients over 60 years old. Information on mortality was obtained by cross-linkage with the Department of Interior population files. The multivariate survival analysis model was utilized to assess the association between the time from fracture incident to surgery and the outcome (1-year survival and postoperative complications).
The hazard ratio (HR) of 1-year mortality for postponing surgery beyond 48 h was 1.63 (95%CI 1.11-2.40), as derived by the Cox proportional hazards model. Other variables found to be independently associated with decreased survival are: male gender (HR=1.54), mental deterioration (HR=2.94), postoperative mobility (HR=2.45), and severity of pre-existing diseases (HR=1.96). Occurrence of general complications during the postoperative hospital stay was a significant predictor of decreased 1-year survival (HR=1.83).
These findings suggest that early (within 48 h) surgical treatment of hip fractures is associated with improved 1-year survival.

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Keywords

1-year mortality
 
1-year survival
 
60 years old
 
651 consecutive hip fracture patients
 
Cox proportional hazards model
 
demographic data
 
fracture incident
 
general complications
 
hip fracture
 
hip fractures
 
hospital records
 
Interior population files
 
mental deterioration
 
multivariate survival analysis model
 
operative delay
 
postoperative complications
 
postoperative hospital
 
postoperative mobility
 
pre-existing diseases
 
subsequent survival