Is 48 h a critical cut-off point for mortality in geriatric hip fractures?

Abstract

Background/aim: In this study, our objective was to evaluate the mortality in geriatric hip fracture patients who were operated within 48 h after admission or after the 48thh. Materials and methods: A total of 194 patients who had undergone surgery for hip fracture between 2016 and 2018 were retrospectively evaluated. Patient information was obtained from the hospital’s database using the ICD codes 81.52, 82.00–82.09, and 82.10. Radiological examination reports were collected from the patient files. Information on mortality was obtained from the Death Notification System of the Turkish Ministry of Health. First-year mortality rates of patients operated within 48 h (Group 1) and those operated at 48–96 h (Group 2) were compared.Results: The mean duration between admission to the hospital and surgical intervention was 33.90 ± 1.95 h (3–96 h). The mean total hospitalization time was 7.29 ± 1.53 days (2–36 days). Of the patients, 62 (32%) died within one year after the operation. The mean survival times for patients operated ≤48 h or >48 h were 8.47 ± 1.90 and 6.57 ± 2.59 months, respectively (Z = 1.074, P = 0.283). There was no significant correlation between survival time and the time delay before the operation (r = –0.103, P = 0.153). Additionally, the Cox regression analysis, including age (years), ASA (grade 3 vs. 2), time to operation (h), and days spent in the ICU, demonstrated no significant independent effect of the time to operation on survival (P = 0.200).Conclusion: Although shortening the time to surgery may have some rationale, we did not find any difference in patients operated before 48 h compared to 48–96 h concerning mortality.

Implementation of Orthogeriatrics in Portugal

“…A time to surgery of less than 48 hours is associated with a better prognosis [ 22 ]. This was not always possible and efforts must be made to avoid surgery delays, which in our hospital centre included increased operating room availability and surgical optimization such as protocols for anticoagulant reversal and systematic cardiorespiratory assessment [ 8 ].…”

“…The Orthogeriatrics Unit of the Vila Nova de Gaia Hospital Centre (CHVNGE) was the first of its kind created in Portugal, with a multidisciplinary team with co-management between internal medicine and orthopaedics [13,14]. The orthogeriatric unit objectives were to decrease in-hospital mortality as well as post-discharge medium and long-term survival and quality of life improvement, through several ways: early treatment of medical complications; prevention and treatment of geriatric syndromes such as frailty, functional limitation, falls, depression, polypharmacy, malnutrition, and cognitive impairment; reduction of pre-surgical waiting; recovery of the previous functional status in the shortest time and at the lowest possible cost; offering higher quality clinical care through daily clinical evaluation, managing complications, pre and post-surgical optimization; functional rehabilitation consultation; nutritional assessment; social assessment; and secondary prevention of bone fractures at discharge [9,[15][16][17][18][19][20][21][22].…”