Key result
Early THA within 48 hours is linked to ~18% lower 30-day readmissions versus delayed surgery.
Why the study?
Limited studies had examined the benefits of early hip arthroplasty within 48 hours from admission to surgery for femoral neck fractures.
Does early arthroplasty within 48 hours reduce in-hospital complications and 30-day readmission in patients with femoral neck fractures?
Cohort (n=146,754)
Yes
Does early arthroplasty within 48 hours reduce in-hospital complications and 30-day readmission in patients with femoral neck fractures?
Odds Ratio: 0.82 (95% CI 0.7–0.95)
Absolute Event Rate: 3.03% vs 3.74%
p-value: p=0.008
Early arthroplasty within 48 hours for femoral neck fractures is associated with reduced risks of deep vein thrombosis, blood transfusion, and 30-day readmission.
Should not yet change practice; hypothesis-generating association leaves causal benefit of early THA timing open for RCTs.
BACKGROUND: Limited studies have examined the benefits of early arthroplasty within 48 h from admission to surgery for femoral neck fractures (FNFs). Using the national inpatient database, the authors aimed to investigate the trends in early arthroplasty within 48 h for FNFs in China and to assess its effect on in-hospital complications and 30-day readmission patterns. MATERIALS AND METHODS: This was a retrospective cohort study. Patients receiving primary total hip arthroplasty (THA) or hemiarthroplasty (HA) for FNFs in the Hospital Quality Monitoring System between 2013 and 2019 were included. After adjusting for potential confounders with propensity score matching, a logistic regression model was performed to compare the differences in in-hospital complications [i.e. in-hospital death, pulmonary embolism, deep vein thrombosis (DVT), wound infection, and blood transfusion], rates and causes of 30-day readmission between early and delayed arthroplasty. RESULTS: During the study period, the rate of early THA increased from 18.0 to 19.9%, and the rate of early HA increased from 14.7 to 18.4% ( P <0.001). After matching, 11 731 pairs receiving THA and 13 568 pairs receiving HA were included. Compared with delayed THA, early THA was associated with a lower risk of pulmonary embolism [odds ratio (OR) 0.51, 95% CI: 0.30-0.88], DVT (OR 0.59, 95% CI: 0.50-0.70), blood transfusion (OR 0.62, 95% CI: 0.55-0.70), 30-day readmission (OR 0.82, 95% CI: 0.70-0.95), and venous thromboembolism-related readmission (OR 0.50, 95% CI: 0.34-0.74). Similarly, early HA was associated with a lower risk of DVT (OR 0.70, 95% CI: 0.61-0.80) and blood transfusion (OR 0.74, 95% CI: 0.68-0.81) than delayed HA. CONCLUSION: Despite a slight increase, the rate of early arthroplasty remained at a low level in China. Given that early arthroplasty can significantly improve prognosis, more efforts are needed to optimize the procedure and shorten the time to surgery.
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Wang et al. (2024) conducted a cohort in Femoral neck fractures (n=146,754). Early arthroplasty (within 48 hours) vs. Delayed arthroplasty (after 48 hours) was evaluated on 30-day readmission (THA patients) (OR 0.82, 95% CI 0.70-0.95, p=0.008). Early total hip arthroplasty within 48 hours for femoral neck fractures was associated with a lower risk of 30-day readmission (OR 0.82) compared to delayed arthroplasty.
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