Moran, J Bone Joint Surg Am 2005 - Early Mortality after Hip Fracture: Is Delay before Surgery Important?

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

Moran, Taylor, et al.·J Bone Joint Surg Am·2005·651 citations·Prospective cohort

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Background

Hip fracture is associated with high mortality among the elderly. Most patients require surgery, but the timing of the operation remains controversial. Surgery within 24 hours after admission has been recommended, but evidence supporting this approach is lacking. The objective of this study was to determine whether a delay in surgery for hip fractures affects postoperative mortality among elderly patients.

Methods

We conducted a prospective, observational study of 2660 patients who underwent surgical treatment of a hip fracture at one university hospital. We measured mortality rates following the surgery in relation to the delay in the surgery and the acute medical comorbidities on admission.

Results

The mortality following the hip fracture surgery was 9% (246 of 2660) at 30 days, 19% at 90 days, and 30% at 12 months.
Of the patients who had been declared fit for surgery, those operated on without delay had a 30-day mortality of 8.7% and those for whom the surgery had been delayed between one and 4 days had a 30-day mortality of 7.3%.
This difference was not significant (p = 0.51).
The 30-day mortality for patients for whom the surgery had been delayed for more than 4 days was 10.7%, and this small group had significantly increased mortality at 90 days (hazard ratio = 2.25; p = 0.001) and one year (hazard ratio = 2.4; p = 0.001).
Patients who had been admitted with an acute medical comorbidity that required treatment prior to the surgery had a 30-day mortality of 17%, which was nearly 2.5 times greater than that for patients who had been initially considered fit for surgery (hazard ratio = 2.3, 95% confidence interval = 1.6 to 3.3; p < 0.001).

Conclusions

The 30-day mortality following surgery for a hip fracture was 9%. Patients with medical comorbidities that delayed surgery had 2.5 times the risk of death within 30 days after the surgery compared with patients without comorbidities that delayed surgery. Mortality was not increased when the surgery was delayed up to 4 days for patients who were otherwise fit for hip fracture surgery. However, a delay of more than 4 days significantly increased mortality.

Copyright remains with the authors and publisher.

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

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

Moran, Taylor, et al.·J Bone Joint Surg Am·2005·651 citations·Prospective cohort

|

Background

Hip fracture is associated with high mortality among the elderly. Most patients require surgery, but the timing of the operation remains controversial. Surgery within 24 hours after admission has been recommended, but evidence supporting this approach is lacking. The objective of this study was to determine whether a delay in surgery for hip fractures affects postoperative mortality among elderly patients.

Methods

We conducted a prospective, observational study of 2660 patients who underwent surgical treatment of a hip fracture at one university hospital. We measured mortality rates following the surgery in relation to the delay in the surgery and the acute medical comorbidities on admission.

Results

The mortality following the hip fracture surgery was 9% (246 of 2660) at 30 days, 19% at 90 days, and 30% at 12 months.
Of the patients who had been declared fit for surgery, those operated on without delay had a 30-day mortality of 8.7% and those for whom the surgery had been delayed between one and 4 days had a 30-day mortality of 7.3%.
This difference was not significant (p = 0.51).
The 30-day mortality for patients for whom the surgery had been delayed for more than 4 days was 10.7%, and this small group had significantly increased mortality at 90 days (hazard ratio = 2.25; p = 0.001) and one year (hazard ratio = 2.4; p = 0.001).
Patients who had been admitted with an acute medical comorbidity that required treatment prior to the surgery had a 30-day mortality of 17%, which was nearly 2.5 times greater than that for patients who had been initially considered fit for surgery (hazard ratio = 2.3, 95% confidence interval = 1.6 to 3.3; p < 0.001).

Conclusions

The 30-day mortality following surgery for a hip fracture was 9%. Patients with medical comorbidities that delayed surgery had 2.5 times the risk of death within 30 days after the surgery compared with patients without comorbidities that delayed surgery. Mortality was not increased when the surgery was delayed up to 4 days for patients who were otherwise fit for hip fracture surgery. However, a delay of more than 4 days significantly increased mortality.

Copyright remains with the authors and publisher.

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