Original Research

Time-to-Surgery for Definitive Fixation of Hip Fractures: A Look at Outcomes Based Upon Delay

Publish date: September 7, 2018

Hasham M. Alvi, MD

Rachel M. Thompson, MD

Varun Krishnan, MD

Mary J. Kwasny, ScD

Matthew D. Beal, MD

David W. Manning, MD

TAKE-HOME POINTS

Time-to-surgery for definitive fixation of hip fractures is a modifiable risk factor.
This study fails to demonstrate a benefit in delaying surgery for medical optimization as there were no time-to-surgery related differences in complications (P = 1.43).
Delay in definitive surgery results in an increase in the total length of stay (P < .001) and surgery-to-discharge time (P < .001) without an improvement in overall complications, readmission or 30-day mortality rates.
Despite numerous investigations, there are no consensus guidelines to decrease complications and mortality rates following hip fracture surgery.
ACS-NSQIP database is a reliable and validated database.

References

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ABSTRACT

The morbidity and mortality after hip fracture in the elderly are influenced by non-modifiable comorbidities. Time-to-surgery is a modifiable factor that may play a role in postoperative morbidity. This study investigates the outcomes and complications in the elderly hip fracture surgery as a function of time-to-surgery.

Using the American College of Surgeons-National Surgical Quality Improvement Program data from 2011 to 2012, a study population was generated using the Current Procedural Terminology codes for percutaneous or open treatment of femoral neck fractures (27235, 27236) and fixation with a screw and side plate or intramedullary fixation (27244, 27245) for peritrochanteric fractures. Three time-to-surgery groups (<24 hours to surgical intervention, 24-48 hours, and >48 hours) were created and matched for surgery type, sex, age, and American Society of Anesthesiologists class. Time-to-surgery was then studied for its effect on the post-surgical outcomes using the adjusted regression modeling.

A study population of 6036 hip fractures was created, and 2012 patients were assigned to each matched time-to-surgery group. The unadjusted models showed that the earlier surgical intervention groups (<24 hours and 24-48 hours) exhibited a lower overall complication rate (P = .034) compared with the group waiting for surgery >48 hours. The unadjusted mortality rates increased with delay to surgical intervention (P = .039). Time-to-surgery caused no effect on the return to the operating room rate (P = .554) nor readmission rate (P = .285). Compared with other time-to-surgeries, the time-to-surgery of >48 hours was associated with prolonged total hospital length of stay (10.9 days) (P < .001) and a longer surgery-to-discharge time (hazard ratio, 95% confidence interval: 0.74, 0.69-0.79) (P < .001). Adjusted analyses showed no time-to-surgery related difference in complications (P = .143) but presented an increase in the total length of stay (P < .001) and surgery-to-discharge time (P < .001).

Timeliness of surgical intervention in a comorbidity-adjusted population of elderly hip fracture patients causes no effect on the overall complications, readmissions, nor 30-day mortality. However, time-to-surgery of >48 hours is associated with costly increase in the total length of stay, including an increased post-surgery-to-discharge time.

Continue to: Despite the best efforts to optimize surgical care...

References

5. Zuckerman JD. Hip fracture. N Engl J Med. 1996;334(23):1519-1525. doi:10.1056/NEJM199606063342307.

6. Marottoli RA, Berkman LF, Cooney LM Jr. Decline in physical function following hip fracture. J Am Geriatr Soc. 1992;40(9):861-866. doi:10.1111/j.1532-5415.1992.tb01980.x.

7. Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477-2481. doi:10.1056/NEJMp1011024.

11. Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am. 2005;87(3):483-489. doi:10.2106/JBJS.D.01796.

18. Rae HC, Harris IA, McEvoy L, Todorova T. Delay to surgery and mortality after hip fracture. ANZ J Surg. 2007;77(10):889-891. doi:10.1111/j.1445-2197.2007.04267.x.

19. Orosz GM, Magaziner J, Hannan EL, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004;291(14):1738-1743. doi:10.1001/jama.291.14.1738.

35. ACS National Surgical Quality Improvement Program. American College of Surgeons Web site. https://www.facs.org/quality-programs/acs-nsqip?. Accessed March 14, 2013.

Time-to-Surgery for Definitive Fixation of Hip Fractures: A Look at Outcomes Based Upon Delay

TAKE-HOME POINTS

References

ABSTRACT

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