The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur

Craik, J.D.; Geleit, Ryan; Hiddema, J; Bray, Emily; Hampton, Robert; Railton, Gil T.; Ward, David A.; Windley, J.

doi:10.1308/rcsann.2019.0032

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…The results supported the former studies of Leer-Salvesen et al, which was also a database investigation of the Norwegian Patient Registry and included 83,727 patients over 10 years [ 19 ]. However, conflicting evidence yielded from the studies of Craik et al [ 20 ] and Lim et al [ 21 ], both of which investigated also an over ten-year period data resulting in no significant differences in regard of complications. The reasons of controversial evidences might be multiple aspects.…”

Section: Discussionmentioning

confidence: 99%

Delayed surgery is associated with adverse outcomes in patients with hip fracture undergoing hip arthroplasty

Liu

Yang

et al. 2023

BMC Musculoskelet Disord

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Background Hip arthroplasty (HA) is one of the most effective procedures for patients with hip fractures. The timing of surgery played a significant role in the short-term outcome for these patients, but conflicting evidence has been found. Methods The Nationwide Inpatient Sample database was investigated from 2002 to 2014 and identified 247,377 patients with hip fractures undergoing HA. The sample was stratified into ultra-early (0 day), early (1–2 days) and delayed (3–14 days) groups based on time to surgery. Yearly trends, postoperative surgical and medical complications, postoperative length of hospital stay (POS) and total costs were compared after propensity scores were matched between groups by demographics and comorbidity. Results From 2002 to 2014, the percentage of hip fracture patients who underwent HA increased from 30.61 to 31.98%. Early surgery groups showed fewer medical complications but higher surgical complications. However, specific complication evaluation showed both ultra-early and early groups decreased most of the surgery and medical complications with increasing post hemorrhagic anemia and fever. Medical complications were also reduced in the ultra-early group, but surgical complications increased. Early surgery groups reduced the POS by 0.90 to 1.05 days and total hospital charges by 32.6 to 44.9 percent than delayed surgery groups. Ultra-early surgery showed no benefit from POS than early group, but reduced total hospital charges by 12.2 percent. Conclusion HA surgery performed within 2 days showed more beneficial effects on adverse events than delayed surgery. But surgeons should be cognizant of the potential increased risks of mechanical complications and post-hemorrhagic anemia.

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Section: Discussionmentioning

confidence: 99%

Delayed surgery is associated with adverse outcomes in patients with hip fracture undergoing hip arthroplasty

Liu

Yang

et al. 2023

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…The results supported the former studies of Leer-Salvesen et al [19], which was also a database investigation of the Norwegian Patient Registry and included 83727 patients over 10 years. However, con icting evidence yielded from the studies of Craik et al [20] and Lim et al [21], both of which investigated also an over ten-year period data resulting in no signi cant differences in regard of complications. The reasons of controversial evidences might be multiple aspects.…”

Section: Discussionmentioning

confidence: 99%

Early versus delayed surgery in hip fracture patients who underwent hip arthroplasty

Liu

Fan

Wang

et al. 2022

Preprint

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Background Hip arthroplasty (HA) is one of the effective procedures for patients with hip fractures. The surgery timing played an important role in the short-term outcomes in these patients, but conflicting evidence reported. Methods The Nationwide Inpatient Sample database was investigated from 2002 to 2014 and identified 247377 patients with hip fractures underwent HA. The sample was stratified into ultra-early (0 day), early (1–2 days) and delayed (3–14 days) groups based on time to surgery. Yearly trends, postoperative surgical and medical complications, postoperative length of hospital stay (POS) and total costs were compared after propensity score matched between groups by demographics and comorbidity. Results The hip fracture patients underwent HA increased from 30.61% in 2002 to 31.98% in 2014. Early surgery groups reduced medical complications but increased surgical complications. However, specific complication evaluation showed both ultra-early and early groups reduced most of the surgical and medical complications with increasing post hemorrhagic anemia and fever. Ultra-early group also reduced medical complications, but increased surgical complication. Early surgery groups reduced the POS by 0.90 to 1.05 days and total hospital charges by 32.6 to 44.9 percent than delayed. Ultra-early surgery showed no beneficial effect of POS than early, but reduced total hospital charges by 12.2 percent. Conclusion HA surgery performed within 2 days showed more beneficial effects over adverse events than delayed. But surgeons should be recognizant of the potential increased risks of mechanical complications and post hemorrhagic anemia.

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“…The optimal time for surgery associated with the lowest risk of complications after hip fracture surgery has been the subject of numerous studies in the literature. While some authors found advantages for surgery within 24 h, others could not confirm these results [1,17,19,[21][22][23][24][25][26][28][29][30][31][32]35,[42][43][44]. These heterogeneous results thus leave room for interpretation also for national guidelines.…”

Section: The Time To Surgery Interval In Hip Fracturesmentioning

confidence: 99%

“…Many studies revealed predictive factors for the occurrence of perioperative complications after hip fracture, such as gender, age, comorbidities, systemic anticoagulation, and the general physical status at the time of the injury [1,11,17,19,[21][22][23][24][25][26][27][28][29][30][31][32]. The most controversial factor recognized and examined in multiple studies on the therapy of hip fractures is the "time-to-surgery" interval [19,33,34].…”

Section: Introductionmentioning

confidence: 99%

“…The most controversial factor recognized and examined in multiple studies on the therapy of hip fractures is the "time-to-surgery" interval [19,33,34]. While some studies found an increased complication rate for surgical procedures performed after 24 h, other study groups found disadvantages for a too-early operation or detected no significant association between the time-to-surgery interval and complication rates [19,[21][22][23][24][25][26]35]. Some guidelines, such as the "German guideline for the treatment of femoral fracture close to the hip joint", recommend surgery for these fractures without differentiating the fracture type patient individual within 24 h after injury [27].…”

Section: Introductionmentioning

confidence: 99%

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Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment

Daginnus,

Schmitt,

Graw

et al. 2023

JPM

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Introduction: Hip fractures are common injuries in the elderly and are usually treated with timely surgery. While severe postoperative complications are reported for up to 10% of patients, many studies identified predictive factors for the occurrence of complications postoperatively. A controversially discussed factor is “time-to-surgery”. The aim of the study was to examine if time-to-surgery was associated with the occurrence of complications and if the complication rate differed between the patient individual fracture types of intracapsular on the one hand and extracapsular hip fractures on the other hand. We hypothesized that time-to-surgery had less impact on complications in intracapsular hip fractures compared to extracapsular ones, and therefore, guidelines should pay attention to the patient individual case scenario. Materials and Methods: All patients who were admitted to the Department of Trauma and Orthopaedic Surgery of an academic teaching hospital for hip fracture surgery (n = 650) over a five-year period were included in the study. After the application of the exclusion criteria, such as periprosthetic or pathologic fractures, cases needed immediate surgical treatment, and after outlier adjustment, 629 cases remained in the study. Hip fractures were classified into intracapsular fractures (treated by hip arthroplasty) and extracapsular fractures (treated by intramedullary nailing osteosynthesis). The occurrence of severe complications in patients treated within 24 h was compared with patients treated later than 24 h after injury. For statistical evaluation, a multivariate logistic regression analysis was performed to investigate the impact of time-to-surgery interval on the occurrence of complications. Results: Patients with an extracapsular fracture, which was treated with intramedullary nailing (44.5%), rarely suffered a serious complication when surgery was performed within 24 h after injury. However, when the interval of the time-to-surgery was longer than 24 h, the complication rate increased significantly (8.63% vs. 25.0%, p = 0.002). In contrast to this finding in patients with intracapsular fractures (55.5%), which were treated with cemented arthroplasty, complication rates did not depend on the 24 h interval (26.17% vs. 20.83%, p = 0.567). Conclusions: The occurrence of complications after surgical treatment of hip fractures is associated with the time interval between injury and surgery. A 24 h time interval between injury and surgical procedure seems to play a major role only in extracapsular fractures treated with osteosynthesis but not in intracapsular fractures treated with arthroplasty. Therefore, guidelines should take notice of the patient individual case scenario and, in particular, the individual hip fracture type.

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The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur

Cited by 8 publications

References 16 publications

Delayed surgery is associated with adverse outcomes in patients with hip fracture undergoing hip arthroplasty

Delayed surgery is associated with adverse outcomes in patients with hip fracture undergoing hip arthroplasty

Early versus delayed surgery in hip fracture patients who underwent hip arthroplasty

Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient’s Individual Type of Fracture and Its Treatment

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