OTA 2012 Posters

Scientific Poster #3 Hip/Femur OTA-2012

Early Intervention for Better Survival Rate After Hip Fracture

Ely L. Steinberg, MD; Amir Sternheim, MD; Assaf Kadar, MD;
Ahuva Melik, MD; Moshe Salai, MD; Ofir Chechik, MD;
Orthopaedic Department, Souraky Tel-Aviv Medical Center,
Tel-Aviv University, Tel-Aviv, Israel

Background/Purpose: Early operative treatment has been advocated for femoral neck fracture fixation. In the present study we retrospectively assessed files of patients operated on in our hospital and tried to evaluate patients’ survival in correlation with time to surgery.

Methods: Data of 1940 patients operated for fracture of the femoral neck between January 2008 and June 2011 were assessed. All patients were assessed for American Society of Anesthesiologists (ASA) and Charlson scores as well as demographic parameters. Patients treated either by hemiarthroplasty, dynamic compression plate, or hip nail were included in the study. There were 1308 females and 632 males with an average age of 77.6 years (range, 17-107). 1248 patients (64%) were treated within 48 hours and 692 (36%) were treated after 48 hours. Survival was assessed using the data received from the national inhabitant registry.

Results: 1-year survival rate for patients with a poor Charlson score was 71%; for moderate, 87%; and for mild, 98%. According to the ASA score, the survival rate for scores 1 or 2 was equal (96%), decreased to 79% for score 3, and further lower for score 4 (64%). Comparing two groups of patients treated within 48 hours and after 48 hours, the survival rates for the first 60 postoperative days were 96% and 93%, respectively, with a hazard ratio of 1.31 for the group operated after 48 hours versus within 48 hours, adjusted for Charlson score for age and sex. Comparing the two groups, the survival rates for 1 year postoperatively were 90% and 81%, respectively, with a hazard ratio of 1.5 for the group operated after 48 hours versus within 48 hours, adjusted for Charlson score for age and sex. Males had an increased hazard ratio at 60 days and at 1 year for age and ASA score.

Conclusions: Early surgery is most important for mobility and preventing early postfracture complications. In the present study we found that early operation within 48 hours increases the survival rate and decreases mortality hazard ratio postoperatively. These results are comparable and even better compared with other published data and we strongly encourage adhering to these recommendations.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.