Key result
Delaying hip fracture surgery for ≥48 hours compared with <24 hours was associated with an increased risk of mortality (10.3% vs 4.8%; OR 2.31; 95% CI 1.47-3.65).
Why the study?
Does delayed elapsed time to surgery increase mortality and length of stay in patients undergoing hip fracture surgery?
Observational (n=3,972)
Does delayed elapsed time to surgery increase mortality and length of stay in patients undergoing hip fracture surgery?
Odds Ratio: 2.31 (95% CI 1.47–3.65)
Absolute Event Rate: 10.3% vs 4.8%
p-value: p=<0.001
Delaying hip fracture surgery beyond 48 hours is associated with a significantly increased risk of mortality and prolonged hospital length of stay.
Supports minimizing delays in hip fracture surgery; leaves open whether timing is causal or confounded.
We evaluated factors and outcomes associated with elapsed time to surgery (ETTS) in 1,081 men and 2,891 women (mean age 83.5 years ±9.1) undergoing hip fracture surgery (from 2009-2019). Mortality rates were 4.8%, 6.3%, 6.2% and 10.3% (chi-squared 19.0; p<0.001), and hospital length of stay (LOS) >19 days were 31.9%, 32.8%, 33.8% and 43.2% (chi-squared 18.5; p<0.001) for ETTS <24 hours, 24-35 hours, 36-47 hours and ≥48 hours, respectively. There were no differences between ETTS categories for failure to mobilise within 1 day of surgery, pressure ulcers or discharge to nursing care. After adjustment for age, sex, American Society of Anesthesiologists' score and years of data collection, compared with Sunday, the risk of ETTS ≥36 hours was highest on Friday (odds ratio (OR) 3.50; 95% confidence interval (CI) 2.43-5.03) and Saturday (OR 4.70; 95% CI 3.26-6.76). Compared with ETTS <24 hours, there were increases in the risk of death when ETTS ≥48 hours (OR 2.31; 95% CI 1.47-3.65) and LOS >19 days (OR 1.34; 95% CI 1.02-1.75). The median (interquartile range (IQR)) LOS for ETTS <24 hours was 12.7 days (IQR 8.0-23.0), 24-35 hours was 13.5 days (IQR 8.4-22.9), 36-47 hours was 14.1 days (IQR 8.9-23.3) and ≥48 hours was 16.9 (IQR 10.8-27.0; p<0.001). The 10-year period of collection did not change the conclusion. Admissions towards the end of the week are associated with delayed ETTS for hip fractures, while delay in surgery, particularly beyond 48 hours, is associated with increased risk of mortality and prolonged LOS.
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Fluck et al. (2022) conducted an observational in Hip fracture (n=3,972). Elapsed time to surgery ≥48 hours vs. Elapsed time to surgery <24 hours was evaluated on Mortality (OR 2.31, 95% CI 1.47-3.65, p=<0.001). Delaying hip fracture surgery for ≥48 hours compared with <24 hours was associated with an increased risk of mortality (10.3% vs 4.8%; OR 2.31; 95% CI 1.47-3.65).
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