Delay from fracture to hospital admission: a new risk factor for hip fracture mortality?

Vidal, Edison Iglesias de Oliveira; Moreira-Filho, D. C.; Pinheiro, Rejane Sobrino; Souza, Rômulo Cristóvão de; Almeida, Liz Maria de; Camargo, Kenneth Rochel de; Boas, Paulo José Fortes Villas; Fukushima, Fernanda Bono; Coeli, Cláudia Medina

doi:10.1007/s00198-012-1917-x

Cited by 36 publications

(32 citation statements)

References 27 publications

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“…It has shown that almost two‐thirds of patients admitted to a public hospital in NSW with a hip fracture underwent surgery on the day of or day after admission. These results are consistent with the international literature where the percentage of people operated on within 48 h ranges between 50 and 87% . However, it should be remembered that this study examined calendar days as opposed to hours to surgery, and as such will underestimate the true proportion of patients undergoing surgery within 48 h.…”

Section: Discussionsupporting

confidence: 91%

“…Optimizing patients for surgery is critical to outcomes and delaying surgery to address modifiable factors in some patients is clinically appropriate . The absence of a significant association between age and time to surgery is consistent with the findings of several other studies examining the causes of operative delay . Gender was also not associated with time to surgery and, while the absolute number and rate of hip fracture in men were less, it is recognized that men tend to have more cardiac disease, including undiagnosed cardiac disease, and do less well than women in relation to medium‐ and longer‐term outcomes …”

Section: Discussionsupporting

confidence: 79%

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Determinants of time to surgery for patients with hip fracture

et al. 2014

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Background: Guidelines for hip fracture care suggest that patients with hip fracture should undergo surgery on the day of or day after admission to hospital. This study examined factors affecting time to surgery for hip fracture extracted from existing administrative datasets in New South Wales (NSW), Australia. Sixty-four per cent of patients received operative treatment on the day of or day after admission. Co-morbidity, type of surgical procedure and day of presentation all impacted significantly on time to surgery. Fourteen per cent required an inter-hospital transfer prior to receiving operative intervention. Transferred patients were 2.6 (95% confidence interval (CI): 2.31-2.85) times more likely to wait 2-4 days and 3.2 times more likely to wait 5 or more days (95% CI: 2.77-3.76) for surgery compared with patients presenting to an operating hospital. Conclusion: Significant variation exists between hospitals in the time to surgery that is not solely explained by measures of case mix or geography. Opportunities exist to consider other factors contributing to this variation and to ensure timely access to surgical intervention in the future.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 79%

Determinants of time to surgery for patients with hip fracture

et al. 2014

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“…Kim et al [14] reported that the operational delay after hospitalization did not affect the incidence of postoperative complications. It was considered by Vidal et al [15,16] that there were no correlations between the length of time from hospitalization to operation and mortality during hospitalization period and 1-year mortality after the operation for patients with brittle hip fracture. However, the length of time from injury to hospitalization is the factor affecting the mortality.…”

Section: Discussionmentioning

confidence: 99%

Effect of time factors on the mortality in brittle hip fracture

Lin

Wang

et al. 2014

J Orthop Surg Res

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ObjectiveThe aim of this research is to study the effect of time factors on the mortality of brittle hip fracture.MethodsThe data of 705 patients of hip fracture hospitalized at our department from 2010 to 2012 were reviewed. Among them, 499 cases undergoing surgical operation over the age of 50 were followed up, and 250 cases had valid follow-up records. The effects of the time from injury to operation, the time from injury to hospitalization and the time from hospitalization to operation on the mortality were analyzed.ResultsThe average duration of follow-up was 21.37 ± 9.77 months. There were 198 cases which were followed up for over 12 months. Nine patients died within 3 months after the hip fracture surgery, and 13 patients died within 1 year. A total of 25 patients died during the follow-up. The survival rate of patients with the interval from injury to surgery longer than 5 days was lower than that of patients with the interval less than or equal to 5 days (p = 0.014). The survival rate of patients with the interval from injury to hospitalization longer than 2 days was lower than that of patients with the interval from injury to hospitalization less than or equal to 2 days (p = 0.003). There was no statistical significance in the survival rate between patients with the interval from hospitalization to surgery longer than 3 days and that of patients with the interval from hospitalization to surgery less than or equal to 3 days (p = 0.973).ConclusionThe operational delay, especially the delay of time from injury to hospitalization, is an important factor affecting the early mortality of hip fracture. The delay of time from hospitalization to operation is mainly due to the consideration of the patients' situation and has no effect on early mortality.

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“…Except for age, all independent variables in the regression models were included as continuous variables. These variables were chosen considering their clinically important significance for pressure ulcer, gait status and mortality [15]–[19].…”

Section: Methodsmentioning

confidence: 99%

Serum Metalloproteinases 2 and 9 as Predictors of Gait Status, Pressure Ulcer and Mortality after Hip Fracture

Gumieiro

Rafacho²,

Gonçalves³

et al. 2013

PLoS ONE

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IntroductionThe aim of this study is to evaluate the serum activity of metalloproteinases (MMPs) -2 and -9 as predictors of pressure ulcer (PU), gait status and mortality 6 months after hip fracture.MethodsEighty-seven patients over the age of 65 admitted to the orthopedic unit from January to December 2010 with hip fracture were prospectively evaluated. Upon admission, patient demographic information, including age, gender and concomitant diseases, was recorded. Blood samples were taken for analysis of MMP -2 and -9 activity by gel zymography and for biochemical examination within the first 72 hours of the patient’s admission, after clinical stabilization. The fracture pattern (neck, trochanteric or subtrochanteric), time from admission to surgery, surgery duration and length of hospital stay were also recorded.ResultsTwo patients were excluded due to the presence of pathological fractures (related to cancer), and three patients were excluded due to the presence of PU before admission. Eighty-two patients, with a mean age of 80.4 ± 7.3 years, were included in the analysis. Among these patients, 75.6% were female, 59.8% had PU, and 13.4% died 6 months after hip fracture. All patients underwent hip fracture repair. In a univariate analysis, there were no differences in serum MMP activity between hip fracture patients with or without PU. In addition, the multiple logistic regression analysis models, which were adjusted by age, gender, length of hospital stay and C-reactive protein, showed that the pro-MMP-9 complexed with neutrophil gelatinase-associated lipocalin form (130 kDa) was associated with gait status recovery 6 months after hip fracture.ConclusionsIn conclusion, serum pro-MMP-9 is a predictor of gait status recovery 6 months after hip fracture.

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Delay from fracture to hospital admission: a new risk factor for hip fracture mortality?

Abstract: If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.

Cited by 36 publications

References 27 publications

Determinants of time to surgery for patients with hip fracture

Determinants of time to surgery for patients with hip fracture

Effect of time factors on the mortality in brittle hip fracture

Serum Metalloproteinases 2 and 9 as Predictors of Gait Status, Pressure Ulcer and Mortality after Hip Fracture

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