Does early surgery prevent Postoperative ICU admission after surgery for the fracture of the hip. Nested case control study of 911 patients

Abstract

Introduction Since most hip fractures are treated surgically, it is imperative to find an optimum fracture-to-surgery time to decrease the potential complications and enhance postoperative outcomes. In comparison to the vast plethora of literature available on surgical delay and its implications on mortality, very little, if any, research is available on the impact of delayed surgery on postoperative ICU admission. The primary objective of our study is to examine the factors influencing post-surgical ICU admission in order to work on preventive strategies to reduce the potential associated morbidity. Material and methods Investigators did a nested case control study in a university hospital. A case was defined as a patient who had postoperative ICU admission while controls were patients who did not have postoperative ICU admission after hip fracture surgery. The primary outcome variable was postoperative ICU admission. The exposure variable was defined as the time to surgery which was categorized into two categories; early and late; the early surgery included patients who were operated within ≤ 48 h and the late included patients who had their surgery >48 h. Information on potential confounders including age, type of the procedure and comorbidities were also obtained. Result reported in-line with STROCSS criteria. Results A total cohort of 1084 hip fracture surgeries were performed from January 2010 to December 2018. After screening for eligibility criteria, 911 patients were eligible for the final simple logistic regression analysis (48 cases and 863 controls). Our exposure variable i.e. time from admission to surgery showed no difference between cases and controls. The odds of being treated with Hemiarthroplasty among cases admitted in ICU was 2.42 times as compared to controls (aOR = 2.42; 95% C.I. 1.21–4.86). Conclusion Our study did not find an association between surgical delay and post-operative ICU admission after accounting for other covariates and potential confounders.

The Impact of Timing of Surgery on Patients with Hip Fractures

“…In 2021, Obada Hasan conducted a case-cohort study that included 911 patients who had undergone hip fracture surgery between 2010 and 2018 [18]. The average age of the patients in this study was 50 years.…”

Development and validation of a novel nomogram of 1-year mortality in the elderly with hip fracture: a study of the MIMIC-III database

“…The decline of physical function and underlying diseases in the elderly can exacerbate the risk of surgery, poor postoperative survival and quality of life,7 8 while conservative treatment increases the time spent in bed which may increase the risk of complications. Therefore, the severity of hip fracture itself and complications such as pulmonary infections, decubitus ulcers and embolism caused by prolonged bed rest can be fatal for the patients,9 10 so many patients may be admitted to the intensive care unit (ICU) for treatment 11…”

“…Therefore, the severity of hip fracture itself and complications such as pulmonary infections, decubitus ulcers and embolism caused by prolonged bed rest can be fatal for the patients, 9 10 so many patients may be admitted to the intensive care unit (ICU) for treatment. 11 Many studies have analysed the risk factors associated with mortality or complications…”