Session VI - Geriatrics

Sat., 10/12/02 Geriatrics, Paper #39, 11:37 AM

Early Mortality after Hip Fracture: Is Delay to Surgery Important?

Christopher G. Moran, MD; Andrew M. Taylor, MD; University Hospital, Nottingham, United Kingdom

Purpose: The aim of this study was to evaluate the perioperative (30-day) mortality after hip fracture and to investigate the variables that influence early mortality after this injury.

Methods: A prospective audit of all patients admitted to the hospital with hip fracture was undertaken over a 30-month period. An independent research assistant collected data on a standardized questionnaire. Data included basic demographic information, co-morbidities, mental test score, mobility, and social status. All patients received prophylactic antibiotics and thromboprophylaxis, and surgery was undertaken on dedicated trauma and hip fracture operating lists. Mortality data were obtained from the National Office for Statistics, where all deaths in our country are registered, allowing complete follow-up data.

Results: There were 1752 patients admitted with hip fracture: 1349 women (77%) and 403 men (23%) with a mean age of 80 years (range, 24 to 103 years). The basic fracture types were intracapsular (N = 991; 57%); extracapsular (N = 683; 39%); subtrochanteric (N = 51; 3%); and periprosthetic (N = 27; 2%). Acute medical problems in 133 patients (8%) delayed anaesthesia. Delays to surgery, because of a lack of theater resources, were common, and only 566 patients (32%) had their hip fracture fixed on the day of admission or the following day. There were 20 deep infections (1%), and 154 patients (9%) died within 30 days of surgery: 56 of these died after hospital discharge. Logistic regression analysis showed that the 30-day mortality was not associated with pre-injury mobility or mental test score (P = 0.224). Any delay to surgery (2 days or more) resulted in a significant increase in mortality (P = 0.0042), and the risk of death increased 21% for every day surgery was delayed (P = 0.05). Sub-group analysis showed that acute medical co-morbidity was the most important factor influencing mortality with an odds ratio for death of 4.9 (P = 0.0007). Delay to surgery in medically fit patients (N = 973) gave an odds ratio for death of 1.6, not statistically significant.

Conclusions: The 30-day mortality for hip fractures was 9%. Acute medical co-morbidities were the most important cause of early postoperative death. Delay of surgery in medically fit patients does not significantly increase the 30-day mortality.