Delay to Surgery of Less Than 12 Hours Is Associated With Improved Short- and Long-Term Survival in Moderate- to High-Risk Hip Fracture Patients

Abstract

Introduction: The effect of delays before surgery of 24 hours, 48 hours, and 72 hours on short- and long-term survival has been investigated comprehensively in hip fracture patients, but with controversial results. However, there is only limited evidence for how a threshold of 12-hour delay before hip fracture surgery affects survival. Materials and Methods: A prospective observational study of 884 consecutive hip fracture patients (age ≥ 65 years) undergoing surgery was carried out in terms of 30- and 365-day survival. A Cox hazard regression survival model was constructed for 724 patients with American Society of Anesthesiologists score ≥3 with adjustments of age, gender, cognition, number of medications on admission, hip fracture type, and prior living arrangements. Results: Patients who underwent surgery within 12 hours had better chances of survival than did those with 12 to 24 hours (hazard ratio [HR]: 8.30; 95% confidence interval [CI]: 1.13-61.4), 24 to 48 hours (HR: 7.21; 95% CI: 0.98-52.9), and >48 hours (HR: 11.75; 95% CI: 1.53-90.2) delay before surgery. Long-term survival was more influenced by nonadjustable patient features, but the adverse effect of >48 hours delay before surgery was noticed with HR: 2.02; 95% CI: 1.08-3.80. Increased age and male gender were significantly associated with worse short- and long-term survival. Discussion/Conclusions: Early hip fracture surgery within 12 hours of admission is associated with improved 30-day survival among patients with ASA score ≥3. Delay to surgery of more than 48 hours has an adverse effect on 365-day survival, but factors related to patients’ comorbidities have a great influence on long-term survival.

Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis

“…Contradicting some earlier studies [18,[27][28][29], gender had no effect on the occurrence of readmissions and death, and age did not affect 30-day readmission rate. Supporting earlier observations [8,9,11,30], a short delay (0-1 days) from admission to surgery had a connection to both lower 30-day readmission rates and fewer 1-year outcomes. A recent study suggests that a delay in hip fracture surgery for more than 12 h after admission impairs 30-day survival especially among patients with severe systemic disease [8] whereas the opposite has been reported as well [30].…”

“…Supporting earlier observations [8,9,11,30], a short delay (0-1 days) from admission to surgery had a connection to both lower 30-day readmission rates and fewer 1-year outcomes. A recent study suggests that a delay in hip fracture surgery for more than 12 h after admission impairs 30-day survival especially among patients with severe systemic disease [8] whereas the opposite has been reported as well [30]. As reasons for the delay were not recorded, these observations could not be confirmed.…”

“…From patients' point of view, hip fracture often leads to decline in quality of life and functional ability and consequently there's an increased need for assistance in daily living and many patients move to more assisted living environments [6,7]. To avoid these adverse consequences, undelayed surgery, rapid mobilization and avoiding complications are essential [8][9][10][11]. Multidisciplinary orthogeriatric care improves the outcomes [12][13][14][15] but the arrangement of such services as well as access to such care vary between countries and regions.…”

No association between waiting time to surgery and mortality for healthier patients with hip fracture: a nationwide Swedish cohort of 59,675 patients

“…Waiting time to surgery for patients with hip fractures has been studied with the hypothesis that longer waiting time is associated with adverse outcomes for those patients (Ryan et al 2015 , Morrisey et al 2017 , Hongisto et al 2019 ). The underlying mechanism as to why prolonged waiting time to surgery would be detrimental is the longer immobilization with a following catabolism (Hedström et al 2006 ) as well as the subsequent increased risk of complications.…”

Zur hüftgelenknahen Femurfraktur des erwachsenen Menschen – Zeitgemäßes klinisches Management auf der Basis internationaler Standards

“…Die rechtzeitige und damit unter Berücksichtigung der patientenbezogenen individuellen Kontextfaktoren so frühzeitig wie möglich durchzuführende, notwendige und angemessene operative Versorgung hüftgelenknaher Frakturen bei den meist durch Fragilität und Multimorbidität gekennzeichneten geriatrischen Patientinnen und Patienten ist signifikant positiv korreliert mit Komplikations-, Morbiditäts- und Mortalitätsraten [17][18][19][20][21][22][23][24][25][26]. Auffälligkeiten bezüglich der präoperativen Ver weildauer als einem "overall"-Qualitätsindikator in der sozialgesetzlich obligaten externen stationären Qualitätssicherung (ESQS) zeigen auch weiterhin -trotz in den letzten Jahren kontinuierlich verbesserter Ergebnisse -dass jedes zehnte Krankenhaus im Strukturierten Dialog als qualitativ auffällig eingestuft wurde (IQTIG Qualitätsreport 2019, Seite 15).…”