Mortality associated with delay in operation after hip fracture: observational study

Abstract

Objective To estimate the number of deaths and readmissions associated with delay in operation after femoral fracture. Design Analysis of inpatient hospital episode statistics. Setting NHS hospital trusts in England with at least 100 admissions for fractured neck of femur during the study period. Main outcome measuresIn hospital mortality and emergency readmission within 28 days. Results There were 129 522 admissions for fractured neck of femur in 151 trusts with 18 508 deaths in hospital (14.3%). Delay in operation was associated with an increased risk of death in hospital, which was reduced but persisted after adjustment for comorbidity. For all deaths in hospital, the odds ratio for more than one day's delay relative to one day or less was 1.27 (95% confidence interval 1.23 to 1.32) after adjustment for comorbidity. The proportion with more than two days' delay ranged from 1.1% to 62.4% between trusts. If death rates in patients with at most one day's delay had been repeated throughout all 151 trusts in this study, there would have been an average of 581 (478 to 683) fewer total deaths per year (9.4% of the total). There was little evidence of an association between delay and emergency readmission. Conclusions Delay in operation is associated with an increased risk of death but not readmission after a fractured neck of femur, even with adjustment for comorbidity, and there is wide variation between trusts.

Mortality After Distal Femur Fractures in Elderly Patients

“…This idea is further supported by studies showing, after adjusting for patient age, gender, and comorbidities, surgical delay greater than 1 day does not lead to an increase of mortality [21,24,30,47]. However, other studies have shown, even after adjusting for comorbidities, surgical delay greater than 48 hours led to an increase in 30-day and 1-year mortality rates [7,34,37,41,50]. Despite the conflicting evidence, we support early surgical intervention in healthy patients and those with minor physiologic abnormalities and attempt to delay surgery only in patients requiring physiologic stabilization or additional preoperative workup [46].…”

“…Mortality rates at 30 days, 6 months, and 1 year after surgery were 6%, 18%, and 25%, respectively ( Table 1). The five patients who died during the first 30 days had an average age of 85.3 years (range, 76-94 years) and an average CCI of 4 (range, [3][4][5][6][7][8]. One 86-year-old patient with a history of prostate cancer and mitral valve repair (CCI, 3) died while in the hospital owing to pneumonia, respiratory failure, and sepsis.…”

“…Patients sustaining a hip fracture have a higher mortality rate than uninjured age-and gender-matched patients [2,3,5,7,13,14,45]. Given the similarity in age and gender distribution of patients with low-energy distal and proximal femur fractures and based on the limited published data, we hypothesized patients with distal femur fractures would have a mortality rate similar to that of patients with fractures of the hip.…”

Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

“…Twenty-one of these were excluded, 13 with insufficient data and eight that did not meet our criteria. Thus, five prospective 13-17 and 11 retrospective studies 5,6,[18][19][20][21][22][23][24][25][26] were included in our analysis. One report 17 was excluded from the analysis of 30-day mortality because of possible duplication with another study; 13 but it was included in the analysis of one-year mortality because the other study 13 was not included in this analysis.…”

“…2 Mortality associated with hip fracture is reported to be 5-10% within 30 days (short-term) and 12-37% within one year (mid-term) after surgery. [1][2][3][4] The Royal College of Physicians' guidelines recommend that surgery be performed within 24 hr after admission 5 because early (vs late) surgical repair is believed to be associated with increased survival; decreased risk of infection, venous thromboembolism or decubitus ulceration; shorter hospital stay; and fewer costs. However, a recent literature review 6 yielded conflicting results on the association between mortality and timing of surgical repair.…”