No association between waiting time to surgery and mortality for healthier patients with hip fracture: a nationwide Swedish cohort of 59,675 patients

Abstract

Background and purpose — Waiting time to surgery for patients with hip fractures and its potential association with mortality has been frequently studied with the hypothesis that longer waiting time is associated with adverse outcomes. However, despite numerous studies, there is no consensus regarding which time frames are appropriate, and whether some patients are more vulnerable to waiting than others. We explored the association between waiting time to surgery and short-term mortality and whether sex, age, surgical method, and comorbidity (ASA) modified this association. Patients and methods — This is a nationwide cohort study of 59,675 patients undergoing hip fracture surgery between January 1, 2013 and December 31, 2017 with a 4-month follow-up of mortality. Data were extracted from the Swedish Registry for Hip Fracture Patients and Treatment (RIKSHÖFT) and mortality was obtained from Statistics Sweden. Results — Unadjusted analyses revealed an association between waiting more than 24 hours for surgery and increased mortality, primarily for women. However, when stratifying for ASA grade, an association persisted only among patients with ASA 3 and 4. Furthermore, the absolute differences in mortality risk between those waiting less or longer than 24 hours were small. Age, fracture type, and surgical method did not modify the association between waiting time and mortality. Interpretation — This study suggests that there may be a need for new guidelines, which take into account the heterogeneity of the patient population.

Good clinical outcome for the majority of younger patients with hip fractures: a Swedish nationwide study on 905 patients younger than 50 years of age

“… 2009 , Greve et al. 2020 ). Other studies have shown a similar low mortality rate after a hip fracture in young patients (Robinson et al.…”

“…Numerous patients suffer from disability after a hip fracture and the 4-month mortality rate has recently been reported to be as high as 16% in patients older than 65 years of age (Greve et al. 2020 ). However, patients with hip fractures do not form a uniform entity.…”

How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

“…Elderly patients with hip fractures have higher mortality risk following surgical delay, a risk that is enhanced in men and patients with multiple comorbidities (Beaupre et al 2019). Greve et al (2020) reported higher mortality in patients with an ASA score of 3-4, but surprisingly also in women, when surgical waiting time was > 24 hours from admission. All this has led to an effort in many countries to operate hip fractures within 24 hours-or as the NICE guidelines in the UK say, "perform surgery on the day of, or the day after, admission" (National Institute for Health and Care Excellence 2011).…”

The association between surgical fixation of hip fractures within 24 hours and mortality

“…(5) Since then, several high-quality registry studies have been published. (11)(12)(13)(14) An updated analysis of existing data is therefore required to review and inform guidelines for the management of hip fractures.…”