Reasons for delaying surgery following hip fractures and its impact on one year mortality

Lizaur-Utrilla, Alejandro; Gonzalez-Navarro, Blanca; Vizcaya-Moreno, María Flores; Miralles‐Muñoz, Francisco A.; González-Parreño, Santiago; Lopez‐Prats, Fernando A.

doi:10.1007/s00264-018-3936-5

Cited by 53 publications

(51 citation statements)

References 29 publications

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“…AHF surgery is usually performed during daytime and as optimization seldom takes place during night, this may render that patients admitted during evening and later, may have less time for pre‐optimization. In line with this, it has been shown that AHF patients receiving active care pre‐surgery do not have increased mortality even if stipulated time limits are exceeded, whereas those whose surgery are postponed due to organizational reasons have higher mortality . Speculatively, ASA III patients, which constitute a major part (almost 50%) of our AHF patients, are perhaps the category of patients that would benefit mostly by pre‐operative optimization even if time‐to‐surgery in some cases may exceeds 24 hours …”

Section: Discussionmentioning

confidence: 71%

The influence of time‐to‐surgery on mortality after a hip fracture

Kristiansson

Hagberg

Nellgård

2019

Acta Anaesthesiol Scand

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Background The effect of time‐to‐surgery on mortality in acute hip fracture (AHF) patients has been debated and studies are inconsistent regarding from what time limit mortality starts to increase. At Sahlgrenska University Hospital/Mölndal, surgery is recommended within 24 hours leaving little time for pre‐operative optimization. However, internationally the definition of early surgery varies between 24 and 48 hours and over. This retrospective study was initiated to investigate the relation between time‐to‐surgery and 30‐day mortality. Method Data of AHF patients from January 2007 through December 2016 were collected. The variables analysed were: age, gender, American Society of Anesthesiologists physical status classification, surgical method (prosthesis or osteosynthesis) and time‐to‐surgery, along with 30‐day mortality. Primary outcome was 30‐day mortality related to time‐to‐surgery divided into groups. Secondary outcome was 30‐day mortality related to time‐to‐surgery analysed hour‐by‐hour. Results From 10,844 eligible patients, 9,270 patients were included into the study. Mean time‐to‐surgery was 19.4 hours and overall 30‐day mortality was 7.6%. Adjusted Cox regression analysis revealed an increased mortality rate in patients with time‐to‐surgery >48 hours. In the hour‐by‐hour analysis, significant mortality increase was observed at 39 hours of time‐to‐surgery. Patients with time‐to‐surgery >24 hours did not have increased mortality compared to patients with time‐to‐surgery <24 hours. Conclusion In AHF patients, a time‐to‐surgery exceeding 39‐48 hours was associated with increased mortality. Patients with surgeries performed before 39‐48 hours did not have increased mortality and this time may, in some patients, be used for optimization prior surgery even if time‐to‐surgery exceeds 24 hours.

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Section: Discussionmentioning

confidence: 71%

The influence of time‐to‐surgery on mortality after a hip fracture

Kristiansson

Hagberg

Nellgård

2019

Acta Anaesthesiol Scand

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“…Pollock et al did not nd male gender being a risk for readmission in 1,486 subjects after hip fracture operations [44]. Lizaur-Utrilla et al found that female gender, higher ASA score and more than 2 comorbidities are risk factors for readmission among 732 subjects after hip fractures [45]. And French et al also found that female gender and multiple comorbidities are risk factors for readmission in 41,331 subjects after hip fractures [46].…”

Section: Discussionmentioning

confidence: 99%

Fresh Unstable Trochanteric Fracture in Elderly Patients: Mortality, Readmission and Reoperation After Primary Hemiarthroplasty

Lin¹,

Wang²,

Lin³

et al. 2021

Preprint

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Objectives: Most unstable trochanteric fractures are treated with internal fixation often with high complication rates. Hemiarthroplasty is an alternative treatment to achieve early weight-bearing, early mobilization and acceptable functional outcomes. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We investigated patients with fresh trochanteric fracture after primary hemiarthroplasty on their long-term outcomes, including mortality, readmission and reoperation.Methods: We studied a total of 2,798 elderly adults who had received hemiarthroplasty for fresh unstable trochanteric fracture from 2000 to 2010, and followed them up until the end of 2012. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation.Results: The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male, older age, larger CCI and lower insured amount were all risk factors for the overall mortality. Older age and larger CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death.Conclusion: Results are consistent with hemiarthroplasty being a robust alternative treatment for unstable trochanteric fracture among a heterogeneous elderly population.

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“…The need for COVID-19 testing procedures before being admitted to the operating room (OR) is an organizational factor that may have increased waiting times. Similarly, waiting for preoperative cardiac tests and other laboratory results may have played a role in delaying surgery [40]. A recent study describes how in Lombardy's hospitals, for instance, patients were isolated at admission and sent to a "filtering" ward until the result of nasopharyngeal swabs became available, with a mean response delay, at that time, of 12 to 24 hours [43].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis

Golinelli

Lenzi

Adorno

et al. 2021

Preprint

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Background. It is of great importance to examine the impact of the healthcare reorganization adopted to confront the COVID19 pandemic on the quality of care provided by healthcare systems to non COVID 19 patients. The aim of this study is to assess the impact of the COVID19 national lockdown (March 9, 2020) on the quality of care provided to patients with hip fracture (HF) in Piedmont and Emilia-Romagna, 2 large regions of northern Italy severely hit by the pandemic. Methods. We calculated the percentage of HF patients undergoing surgery within 2 days of hospital admission. An interrupted time-series analysis was performed on weekly data from December 11, 2019 to June 9, 2020 (6 months), interrupting the series in the 2nd week of March. The same data observed the year before were included as a control time series with no intervention (lockdown) in the middle of the observation period. Results. Before the lockdown, 2day surgery was 69.9% in Piedmont and 79.2% in Emilia-Romagna; after the lockdown, these proportions were equal to 69.8% (-0.1%) and 69.3% (-9.9%), respectively. While Piedmont did not experience any drop in the amount of surgery, Emilia-Romagna exhibited a significantly decline at a weekly rate of -1.29% (95% CI = -1.71 to -0.88). Divergent trend patterns in the 2 study regions reflect local differences in pandemic timing as well as in healthcare services capacity, management, and emergency preparedness.

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Reasons for delaying surgery following hip fractures and its impact on one year mortality

Cited by 53 publications

References 29 publications

The influence of time‐to‐surgery on mortality after a hip fracture

The influence of time‐to‐surgery on mortality after a hip fracture

Fresh Unstable Trochanteric Fracture in Elderly Patients: Mortality, Readmission and Reoperation After Primary Hemiarthroplasty

COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis

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