Admission delay is associated with worse surgical outcomes for elderly hip fracture patients: A retrospective observational study

Abstract

BACKGROUND: The influence of surgical delay on mortality and morbidity has been studied extensively among elderly hip fracture patients. However, most studies only focus on the timing of surgery when patients have already been hospitalized, without considering pre-admission waiting time. Therefore, the present study aims to explore the infl uence of admission delay on surgical outcomes. METHODS: In this retrospective study, we recorded admission timing and interval from admission to surgery for included patient. Other covariates were also collected to control confounding. The primary outcome was 1-year mortality. The secondary outcomes were 1-month mortality, 3-month mortality, ICU admission and postoperative pneumonia. We mainly used multivariate logistic regression to determine the effect of admission timing on postoperative outcomes. An additional survival analysis was also performed to assess the impact of admission delay on survival status in the fi rst year after operation. RESULTS: The proportion of patients hospitalized on day 0, day 1, day 2 after injury was 25.4%, 54.7% and 66.3%, respectively. And 12.6% patients visited hospital one week later after injury. Mean time from admission to surgery was 5.2 days (standard deviation 2.8 days). Hospitalization at one week after injury was a risk factor for 1-year mortality (OR 1.762, 95% CI 1.026-3.379, P=0.041) CONCLUSION: Admission delay of more than one week is signifi cantly associated with higher 1-year mortality. As a supplement to the current guidelines which emphasizes early surgery after admission, we also advocate early admission once patients get injured.

Access to surgical care in Ethiopia: a cross-sectional retrospective data review

“…Prolonged pre-admission waiting time worsens surgical outcome, pre-operative anxiety score, and depression [ 23 , 24 ]. Moreover, it may also result in post-operative complications, mortality and increased hospitalization stay, and catastrophic costs [ 25 ].…”

Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study

“…Further studies with larger sample sizes are required to confirm our findings. Second, we did not obtain some variables related to survival, such as body mass index [ 43 ], time from fracture to hospital admission [ 44 ]. These unadjusted potential confounding factors may influence the results of this study.…”

Risk Factors for postoperative medical morbidity and 3-month mortality in elderly patients with hip fracture following hip arthroplasty during COVID-19 pandemic

“…When patients sustain a hip fracture, they are forced to lie at in a bed and are either in pain or needing analgesic medications, which often have sideeffects. Previous study found that patients who received operation within 2 days after injury had lower inhospital mortality and had better outcomes [29][30][31]. In this study, we found the mean fracture to operation duration was 7.10 days in COVID-19 pandemic group, and 5.31 days in no COVID-19pandemic group, the difference between the two groups was about 2 days, and the incidence of postoperative medical conmplications and 3-month mortality was 21.90% and 5.20% for COVID-19 pandemic group compared to 12.53% and 3.22% for no COVID-19 pandemic group in patients ≥ 70 years with hip fracture following HA.…”