Thurs., 10/4/12 Hip Fractures, PAPER #36, 4:29 pm OTA-2012
Delay to Surgery in Hip Fracture Patients: Effect on Mortality, Length of Stay and Postoperative Morbidity
Reshid Berber, MBBS; Christopher G. Moran, MD, FRCS;
Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
Purpose: This study was undertaken to determine whether a delay to surgery (>36 hours) affects mortality rate, length of stay, and postoperative complications following hip fracture surgery in elderly patients.
Methods: Data were collected by dedicated audit staff using a pro forma designed in accordance with the “Standardised Audit of Hip Fractures in Europe” (SAHFE). This was a prospective observational study; all patients (n = 7207) who were admitted and underwent surgery during a 10-year period from May 1999 to May 2009 have been considered. χ2 tests and independent-sample t tests were used for basic statistical analyses. Mortality data were analysed using Kaplan-Meier survival analysis and Cox regression analysis. P <0.05 was considered significant.
Results: The 30-day mortality was 9.5%. At 90 days, mortality was 18.9% and at 1 year it was 31.4%. In patients declared fit for surgery on admission (n = 5665), 30-day mortality was 7.5% in those operated on without delay, rising to 10.3% at over 4 days’ delay (P = 0.117). However, for those operated on after 5-day delay, 30-day mortality equaled 13.6% (P = 0.009). Those declared fit for surgery on admission stayed a total 14.5 days if operated within 36 hours, rising to 16 days with over 36 hours’ delay (P <0.001). An increase in the rate of urinary tract infection (3.9 vs 5.9%, P <0.001) was seen in patients delayed by over 36 hours. However, when considering all patients together, an increase in both urinary tract infection (3.9% vs 6.1%, P <0.001) and chest infections (7.9% vs 11.3%, P <0.001) was seen with over 36 hours’ delay to surgery.
Conclusion: The 30-day mortality following hip fracture surgery is 9.5%. Patients admitted without comorbidities have significantly increased mortality when surgery is delayed by over 5 days. A 36-hour delay to surgery significantly increases length of stay. Urinary tract infection was the only postoperative morbidity to rise with delay to surgery in fit patients.
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