August 31, 2019

Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients?

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hip fracture (n=83727). Intervention: Total delay to surgery exceeding 48 hours vs. Total delay less than 48 hours. Primary outcome: Three-day mortality (RR 1.69, 95% CI 1.23-2.34, p=0.001).

Resultado clave

Total delay to hip fracture surgery exceeding 48 hours was associated with increased three-day mortality (RR 1.69; 95% CI 1.23-2.34; P=0.001) and one-year mortality.

Diseño del estudio

Tipo

Cohort (n=83,727)

Multicéntrico

Sí

PICO estructurado

Does delay to hip fracture surgery increase mortality and intraoperative medical complications in patients ≥50 years of age?

Población

83,727 hip fracture patients aged 50 years and older from Norwegian national registries, evaluated for the impact of surgical delay on mortality and intraoperative complications.

Exposición

Delay to hip fracture surgery (total delay >48 hours, hospital delay >24 hours)

Comparador

Shorter delays to surgery (≤12 hours, 13-24 hours, 25-36 hours, 37-48 hours)

Resultado

Mortality (three-day and one-year) and intraoperative medical complicationshard clinical

Delaying hip fracture surgery beyond 48 hours from fracture increases short- and long-term mortality, and hospital delays over 24 hours increase intraoperative medical complications.

Resultado numérico

Relative Risk: 1.69 (95% CI 1.23–2.34)

valor p: p=0.001

Resumen

AIMS: The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR). PATIENTS AND METHODS: A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours. RESULTS: Mortality remained unchanged when total delay was less than 48 hours. Total delay exceeding 48 hours was associated with increased three-day mortality (RR 1.69, 95% confidence interval (CI) 1.23 to 2.34; p = 0.001) and one-year mortality (RR 1.06, 95% CI 1.04 to 1.22; p = 0.003). More intraoperative medical complications were reported when hospital delay exceeded 24 hours. CONCLUSION: 2019;101-B:1129-1137.

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Cite This Study

Leer-Salvesen et al. (Sat,) conducted a cohort in Hip fracture (n=83,727). Total delay to surgery exceeding 48 hours vs. Total delay less than 48 hours was evaluated on Three-day mortality (RR 1.69, 95% CI 1.23-2.34, p=0.001). Total delay to hip fracture surgery exceeding 48 hours was associated with increased three-day mortality (RR 1.69; 95% CI 1.23-2.34; P=0.001) and one-year mortality.

synapsesocial.com/papers/6a2419df003b3cd7fea64188 https://doi.org/https://doi.org/10.1302/0301-620x.101b9.bjj-2019-0295.r1

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