Factors delaying surgical treatment of hip fractures in elderly patients

Charalambous, Constadina; Yarwood, S; Paschalides, C; Siddique, Ibrahim; Hirst, P; Paul, A. J.

doi:10.1308/003588403321219911

Cited by 41 publications

(42 citation statements)

References 6 publications

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“…20 In the present study, 53% of surgical fixations were performed within 24 hours compared with rates varying from 10% to 72% in the literature. 6,10,[21][22][23] Surgery was performed within 48 hours in 87% of cases, a good performance compared with published rates varying from 59% to 87%. 11,22,24 On this basis, our system may be qualified as efficient.…”

Section: Discussionmentioning

confidence: 82%

Is the Delay to Surgery for Isolated Hip Fracture Predictive of Outcome in Efficient Systems?

Bergeron

Lavoie

Moore

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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Preoperative delay does not entail adverse outcomes when the surgery is delayed to allow for treatment of comorbid medical conditions. Preoperative delay is associated with a longer hospital stay. The presence of comorbidity only partly explains preoperative delay and adverse outcomes. A prospective study coding for the severity of comorbid conditions and the justification of the preoperative delay will be required to fully elucidate the link between delay and outcome.

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Section: Discussionmentioning

confidence: 82%

Is the Delay to Surgery for Isolated Hip Fracture Predictive of Outcome in Efficient Systems?

Bergeron

Lavoie

Moore

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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“…En un reciente trabajo se aprecia que el principal motivo es la ausencia de quirófano disponible, muy por encima de las razones médicas que pudieran contraindicar la cirugía precoz 19 . También hay comunicaciones en sentido inverso, en las que se muestra que la principal causa de demora es fundamentalmente clínica 38 .…”

Section: Discussionunclassified

Mortalidad y costes asociados a la demora del tratamiento quirúrgico por fractura de cadera

Etxebarría-Foronda

Mar

Arrospide

et al. 2013

Rev. Esp. Salud Publica

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RESUMENFundamentos: La intervención quirúrgica en las fracturas de cadera suele demorarse varios días. Nuestro trabajo tiene dos objetivos. Estudiar la estancia preoperatoria de los pacientes ingresados por fractura de cadera en los hospitales vascos durante el año 2010 y medir su posible asociación con la mortalidad intrahospitalaria, y estimar el coste económico que supone la estancia preoperatoria.Métodos. Se realizó un estudio observacional analizando los siguientes datos del Conjunto Mínimo Básico de Datos (CMBD): hospital, edad, sexo, estancia preoperatoria, estado al alta, diagnósticos asociados y procedimiento quirúrgico. Además, se estudió el índice de comorbilidad de Charlson y se calculó el coste unitario de la estancia pre y postoperatoria mediante modelos de regresión múltiple.Resultados. Se analizó una muestra de 1.856 intervenciones. La estancia preoperatoria fue de 2,7 días y la postoperatoria de 9,7 días. El coste medio por ingreso fue de 12.552,12 euros. El coste medio de la estancia preoperatoria fue de 1295,5 euros. La mortalidad fue del 5%.Conclusiones. La estancia preoperatoria no es un factor estadística-mente asociado con la mortalidad, aunque aumenta significativamente el coste total. No encontramos una asociación entre la demora quirúrgica y la mortalidad, aunque sí tiene una clara influencia en el coste total del proceso. La reducción del tiempo prequirúrgico permite ahorrar costes. Background: Hip fractures surgery is often delayed for several days. The present work has two objectives. The first one is to determine the preoperative hospital length of stay of patients with a hip fracture in our region and its possible correlation with an increase in mortality rate. Secondly we assessed the healthcare expenditure associated to this preoperative period.

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“…This was done because findings from the literature suggest that the availability of operating theatre or of the surgeon according to the week day has an impact on the delay of surgery [19].…”

Section: Methodsmentioning

confidence: 99%

“…In addition to demographic and clinical characteristics, process variables may account for surgical delay and play a role in the causal chain leading to mortality, for instance, the time necessary to optimise patient's medical conditions and the availability of the operating theatre [19].…”

Section: Introductionmentioning

confidence: 99%

Hip fracture: effectiveness of early surgery to prevent 30-day mortality

Carretta

Bochicchio

Rucci

et al. 2010

International Orthopaedics (SICOT)

102

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To estimate the effect of delay to surgery for hip fracture on 30-day mortality using a risk adjustment strategy to control for the effect of demographic and clinical confounders. This observational study was carried out on all patients admitted with a hip fracture and discharged between January 2004 and December 2007 from a teaching hospital. Gender, age, time to surgery, mortality and medical comorbidities were derived from hospital discharge records (SDO), while International Normalised Ratio (INR) and American Society of Anaesthesiologists (ASA) score were retrieved from clinical records. Backward stepwise logistic regression was used to identify potential confounders in the relationship between time to surgery and mortality. A final multivariate logistic regression analysis was carried out controlling for the effect of confounders. In the 1320 patients who underwent surgery (mean age = 83 years, % female = 76.8%), time to surgery was two days or less in 746 (56.5%) patients and 30-day mortality was 3.5%. The interventions included partial or total hip replacement (N=820, 62.1%) and reduction and internal fixation (N=500, 37.9%). Multivariate logistic regression analysis showed that patients with a time to surgery greater than two days had a 2-fold increase in 30-day mortality after adjusting for age, gender, and comorbidity (OR=1.992, 95% CI 1. 065-3.725). In a second model also including ASA score the odd ratio decreased to 1.839 (95% CI 0.971-3.486). Patients with a hip fracture should have surgery within two days from admission in order to reduce 30-day mortality.

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Factors delaying surgical treatment of hip fractures in elderly patients

Cited by 41 publications

References 6 publications

Is the Delay to Surgery for Isolated Hip Fracture Predictive of Outcome in Efficient Systems?

Is the Delay to Surgery for Isolated Hip Fracture Predictive of Outcome in Efficient Systems?

Mortalidad y costes asociados a la demora del tratamiento quirúrgico por fractura de cadera

Hip fracture: effectiveness of early surgery to prevent 30-day mortality

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