OTA 2012 Posters

Scientific Poster #12 Hip/Femur OTA-2012

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

Ryan E. Bennett, MD; Andrea J. Vlasak, MD; Steve R. Gammon, MD;
Sandy Vang, BS; Julie A. Switzer, MD;
University of Minnesota/Regions Hospital, Minneapolis-St. Paul, Minnesota, USA

Background/Purpose: Approximately 300,000 hip fractures occur yearly within the United States. This number is projected to double by 2050. Mortality rates for all patients with hip fractures approach 30%, and perioperative complications are common. In spite of the high complication rate associated with hip fractures in the elderly population, surgical repair of these fractures is often undertaken at night. Multiple studies in the general medical literature have found that work done at night is more likely to result in complications. There is, however, little evidence regarding the effect of the time of day on the outcome of surgical repair of hip fractures. We present a retrospective study comparing the outcomes of surgery for hip fractures based on the time of day of surgery. Our hypothesis was that hip fracture patients who have surgery in the evening or night have worse outcomes than those who have surgery during the day.

Methods: A retrospective study of was performed on 1552 consecutive patients with a diagnosis of intertrochanteric, subtrochanteric, or femoral neck fracture from 2005 to 2010 at a single Level I trauma center. 860 patients met the inclusion criteria (age ≥50 years, isolated injury, and surgical treatment of the fracture). Surgeries were grouped by time of surgical incision into an AM group (07:00-15:59) and a PM group (16:00-06:59). Medical records were analyzed for age, comorbidities, American Society of Anesthesiologists (ASA) class, 30-day mortality, readmission, reoperation, time to surgery, procedure length, total time in the operating room, intraoperative fracture, and medical complications (myocardial infarction, cardiac event, stroke, central nervous system event, pneumonia, urinary tract infection, postoperative wound infection, bleeding requiring transfusion of three or more red blood cell units).

Results: 860 patients met the inclusion criteria. 660 patients underwent surgery in the time period designated as the AM group. 200 patients underwent surgery in the time period designated as the PM group. There was no statistical difference between the groups regarding age, ASA score, Charlson comorbidity index, gender, or fracture type. The overall 30-day mortality was 7.8%. The total complication rate was 28%. There was no significant difference found in either 30-day mortality or total complication rate based on the time of day that the surgery was performed (P = 0.88 and P = 0.86, respectively). This remained unchanged when ASA class, Charlson comorbidity index, and age were taken into account. A multivariate analysis of the risk factors collected was performed to determine which factors did affect outcomes in our study. Age (odds ratio [OR] = 1.034/year), Charlson score (OR = 1.155), ASA class (OR = 1.405), and total operating room time (OR = 1.688) were all found to predict adverse outcomes. Female gender was found to be protective (OR = 0.679). Type of surgery, fracture site, total surgery time, and surgery time of day did not predict adverse outcomes.

Conclusion: In our study population, surgical time of day did not affect the 30-day mortality or number of complications. As the number of hip fractures increases, the demands on orthopaedic surgeons will increase as well. Surgical treatment within 48 hours has been shown to reduce morbidity and mortality of hip fractures. Our study shows that operating after hours did not increase the risk of adverse events surrounding surgery. Age, ASA class, Charlson comorbidity index, and total time in the operating room were predictive of adverse outcomes. This information may be used to discuss the risks of the surgical repair of hip fractures with patients and their families.

• 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.