Length of stay, mortality, morbidity and delay to surgery in hip fractures

Abstract

Our aim was to determine the effect of delay to surgery on the time to discharge, in-hospital death, the presence of major and minor medical complications and the incidence of pressure sores in patients with a fracture of the hip. All patients admitted to Vancouver General Hospital with this injury between 1998 and 2001 inclusive were identified from our trauma registry. A review of the case notes was performed to determine the delay in time from admission to surgery, age, gender, type of fracture and medical comorbidities. A time-to-event analysis was performed for length of stay. Additionally, a Cox proportional hazards model was used to determine the effect of delay to surgery on the length of stay while controlling for other pertinent confounding factors. Using logistical regression we determined the effect of delay to surgery on in-hospital death, medical complications and the presence of pressure sores, while controlling for confounding factors. Delay to surgery (p = 0.0255), comorbidity (p < 0.0001), age (p < 0.0001) and type of fracture (p = 0.0004) were all significant in the Cox proportional hazards model for increased time to discharge. Delay to surgery was not a significant predictor of in-hospital mortality. However, a delay of more than 24 hours was a significant predictor of a minor medical complication (odds ratio (OR) 1.53, 95% confidence interval (CI) 1.05 to 2.22), while a delay of more than 48 hours was associated with an increased risk of a major medical complication (OR 2.21, 95% CI 1.01 to 4.34), a minor medical complication (OR 2.27, 95% CI 1.38 to 3.72) and of pressure sores (OR 2.29, 95% CI 1.19 to 4.40). Patients with a fracture of the hip should have surgery early to lessen the time to acute-care hospital discharge and to minimise the risk of complications.

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

“…Incluso hay autores que señalan que realizar la intervención dentro de las 6 primeras horas mejora los resultados de mortalidad y funcionales 25 . La mayoría de los trabajos reconocen que una cirugía "temprana" podría tener como punto de corte las primeras 48 horas e influye de una manera positiva en las tasas de mortalidad 15,20,22,[25][26][27][28][29][30][31][32] . Sin embargo, también hay autores que ponen en duda tal aseveración 14,23,33,34 .…”

Cost estimates of spinal versus general anaesthesia for fractured neck of femur surgery

“…Indeed, the total cost of anaesthesia for cemented hemi-arthroplasty (Thompson's) is similar to that of the prosthesis inserted, before accounting for the costs of operating room personnel and equipment. Furthermore, ward costs account for 84% of expenditure, and at a daily rate of approximately £500, this suggests that measures aimed at reducing the length of hospital stay (for example, through early operation [27], use of multidisciplinary integrated care pathways [28] and orthogeriatric input [29]) are likely to produce the greatest financial savings. We would also suggest that there might be a financial incentive in amalgamating hospital and social care budgets for patients sustaining hip fracture, to expedite early transfer to community rehabilitation facilities.…”

Short-term and Long-term Orthopaedic Issues in Patients With Fragility Fractures

“…Many studies recommend performing surgery for patients with hip/femur fracture within the first 24 to 48 hours of admission [16,32,61,65,77,84]. Early surgery has been associated with reduced minor and major complications [2,54]. Early surgery also reduces the negative effects of immobility on the patients.…”