What does this research mean for the field?

Early surgery for hip fracture (within 24 hours) does not improve functional outcomes or mortality, but it is associated with reduced pain, shorter hospital length of stay, and fewer major complications in medically stable patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To examine whether the timing of surgical repair for hip fracture is associated with post-treatment functional independence, survival, pain, and hospital length of stay.

April 14, 2004JAMAOpen Access

Association of Timing of Surgery for Hip Fracture and Patient Outcomes

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Why the study?

Does early surgical repair (≤24 hours) improve function, survival, pain, and length of stay in patients aged 50 years or older with hip fracture compared to late surgery?

Population

1206 patients aged 50 years or older admitted with hip fracture

Comparison

Early surgical repair of hip fracture (≤24 hours) vs Late surgical repair of hip fracture (>24 hours)

Design

Cohort

Authors

GOGretchen M. OroszUniversity of Mary

Discussion

Member takes

Implication

Earlier surgery was associated with less pain and shorter stay but not mortality or function; leaves open need for randomized trials in hip fracture.

Key Points

To examine whether the timing of surgical repair for hip fracture is associated with post-treatment functional independence, survival, pain, and hospital length of stay.
Prospective cohort study of 1206 patients aged ≥50 years admitted with hip fracture across four hospitals in the New York City metropolitan area over 29 months.
Compared early surgery (≤24 hours) versus late surgery (>24 hours) among 1178 surgically treated patients using propensity score matching and subgroup analysis of medically stable patients.
Outcomes included survival, Functional Independence Measure scores, pain duration, length of stay, and major complications.
Surgery within 24 hours occurred in 33.8% of patients and was not significantly associated with mortality (HR, 0.75; 95% CI, 0.52-1.08) or locomotion scores (difference, -0.04 points; 95% CI, -0.49 to 0.39).
Earlier surgery significantly decreased days of severe or very severe pain (difference, -0.22 days; 95% CI, -0.41 to -0.03) and shortened overall hospital length of stay by 1.94 days (P < .001), though postoperative pain and postoperative stay did not differ.
Among medically stable patients eligible for early surgery, intervention within 24 hours was associated with significantly reduced major complications (OR, 0.26; 95% CI, 0.07-0.95).

Structured PICO

Does early surgical repair (≤24 hours) improve function, survival, pain, and length of stay in patients aged 50 years or older with hip fracture compared to late surgery?

Population

1206 patients aged 50 years or older admitted with hip fracture

Intervention

Early surgical repair of hip fracture (≤24 hours)

Comparator

Late surgical repair of hip fracture (>24 hours)

Outcome

Function (using the Functional Independence Measure), survival, pain, and length of stay (LOS)

Early surgery for hip fracture in medically stable patients reduces pain, length of stay, and major complications, though it does not significantly improve mortality or functional outcomes.

Cite This Study

Gretchen M. Orosz (2004) studied this question.

synapsesocial.com/papers/6a1b8fa4db618aee6aac0db6 https://doi.org/10.1001/jama.291.14.1738

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Implication

Earlier surgery was associated with less pain and shorter stay but not mortality or function; leaves open need for randomized trials in hip fracture.

Association of Timing of Surgery for Hip Fracture and Patient Outcomes

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Association of Timing of Surgery for Hip Fracture and Patient Outcomes

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider