Early versus delayed surgery in hip fracture patients who underwent hip arthroplasty

Abstract

Background Hip arthroplasty (HA) is one of the effective procedures for patients with hip fractures. The surgery timing played an important role in the short-term outcomes in these patients, but conflicting evidence reported. Methods The Nationwide Inpatient Sample database was investigated from 2002 to 2014 and identified 247377 patients with hip fractures underwent HA. The sample was stratified into ultra-early (0 day), early (1–2 days) and delayed (3–14 days) groups based on time to surgery. Yearly trends, postoperative surgical and medical complications, postoperative length of hospital stay (POS) and total costs were compared after propensity score matched between groups by demographics and comorbidity. Results The hip fracture patients underwent HA increased from 30.61% in 2002 to 31.98% in 2014. Early surgery groups reduced medical complications but increased surgical complications. However, specific complication evaluation showed both ultra-early and early groups reduced most of the surgical and medical complications with increasing post hemorrhagic anemia and fever. Ultra-early group also reduced medical complications, but increased surgical complication. Early surgery groups reduced the POS by 0.90 to 1.05 days and total hospital charges by 32.6 to 44.9 percent than delayed. Ultra-early surgery showed no beneficial effect of POS than early, but reduced total hospital charges by 12.2 percent. Conclusion HA surgery performed within 2 days showed more beneficial effects over adverse events than delayed. But surgeons should be recognizant of the potential increased risks of mechanical complications and post hemorrhagic anemia.