Timing of Adverse Events Following Geriatric Hip Fracture Surgery: A Study of 19,873 Patients in the American College of Surgeons National Surgical Quality Improvement Program
Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Dr. Bohl and Dr. Basques are Orthopaedic Surgery Residents, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois. Dr. Samuel and Dr. Ondeck are Orthopaedic Surgery Residents, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. Dr. Webb is an Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Lukasiewicz is an Orthopaedic Surgery Resident, Mr. Anandasivam is a Research Fellow, and Dr. Grauer is a Professor, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Address correspondence to: Jonathan N. Grauer, MD, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT 06510 (tel, 203-737-7463; fax, 203-785-7132; email, jonathan.grauer@yale.edu).
Daniel D. Bohl, MD, MPH Andre M. Samuel, MD Matthew L. Webb, MDAdam M. Lukasiewicz, MD Nathaniel T. Ondeck, MD Bryce A. Basques, MD Nidharshan S. Anandasivam, BS Jonathan N. Grauer, MD . Timing of Adverse Events Following Geriatric Hip Fracture Surgery: A Study of 19,873 Patients in the American College of Surgeons National Surgical Quality Improvement Program. Am J Orthop.
September 27, 2018
TAKE-HOME POINTS
The median postoperative day of diagnosis for myocardial infarction was 3, 3 for cardiac arrest requiring cardiopulmonary resuscitation, 3 for stroke, 4 for pneumonia, 4 for pulmonary embolism, 7 for urinary tract infection, 9 for deep vein thrombosis, 9 for sepsis, 11 for mortality, and 16 for surgical site infection.
For the earliest diagnosed adverse events, the rate of adverse events had diminished by postoperative day 30; however, for the later diagnosed adverse events, the rate of adverse events remained high at postoperative day 30.
The proportions of adverse events diagnosed prior to discharge were 81.0% for myocardial infarction, 77.8% for stroke, 76.1% for cardiac arrest requiring cardiopulmonary resuscitation, 71.9% for pulmonary embolism, 71.1% for pneumonia, 58.0% for urinary tract infection, 52.1% for sepsis, 46.9% for deep vein thrombosis, 44.3% for mortality, and 27.6% for surgical site infection.
These results facilitate targeted clinical surveillance, guide patient counseling, and inform the duration of follow-up required in research studies.
Clinicians should have the lowest threshold for testing for each adverse event during the time period of greatest risk.
References
ABSTRACT
This study uses a prospective surgical registry to characterize the timing of 10 postoperative adverse events following geriatric hip fracture surgery. There were 19,873 patients identified who were ≥70 years undergoing surgery for hip fracture as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The median postoperative day of diagnosis (and interquartile range) for myocardial infarction was 3 (1-5), cardiac arrest requiring cardiopulmonary resuscitation 3 (0-8), stroke 3 (1-10), pneumonia 4 (2-10), pulmonary embolism 4 (2-11), urinary tract infection 7 (2-13), deep vein thrombosis 9 (4-16), sepsis 9 (4-18), mortality 11 (6-19), and surgical site infection 16 (11-22). For the earliest diagnosed adverse events, the rate of adverse events had diminished by postoperative day 30. For the later diagnosed adverse events, the rate of adverse events remained high at postoperative day 30. Findings help to enable more targeted clinical surveillance, inform patient counseling, and determine the duration of follow-up required to study specific adverse events effectively. Orthopedic surgeons should have the lowest threshold for testing for each adverse event during the time period of greatest risk.
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