What is the clinical evidence from this study?

Study design: Observational. Population: hip fracture (n=2660). Intervention: Delay in surgery (1 to 4 days) vs. Surgery without delay. Primary outcome: thirty-day mortality (p=0.51).

What question did this study set out to answer?

To determine if surgery delay influences postoperative mortality in elderly patients with hip fractures.

March 1, 2005Journal of Bone and Joint Surgery

Early Mortality After Hip Fracture

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Key result

Delaying hip fracture surgery by 1-4 days did not increase 30-day mortality compared to no delay (7.3% vs 8.7%, p=0.51), but delays >4 days significantly increased 90-day mortality (HR 2.25).

Why the study?

Does a delay in surgery for hip fractures affect postoperative mortality among elderly patients?

Population

2660 elderly patients who underwent surgical treatment of a hip fracture at one university hospital

Comparison

Delay in surgery for hip fractures vs Surgery without delay

Design

Cohort

Follow-up

12 months

Authors

CMChristopher G. MoranNottingham University Hospitals NHS Trust RWR. WennHull and East Yorkshire Hospitals NHS Trust MSManoj SikandSandwell & West Birmingham Hospitals NHS Trust

Discussion

Member takes

Implication

Delay for medical optimization was not linked to higher mortality; leaves open whether expedited surgery improves survival independent of comorbidities.

Key Points

To determine if surgery delay influences postoperative mortality in elderly patients with hip fractures.
Prospective observational study of 2660 patients undergoing hip fracture surgery at one university hospital.
Measured mortality rates in relation to surgery delay and acute medical comorbidities upon admission.
Analyzed thirty-day mortality across different surgery delay intervals.
Thirty-day mortality was 9% overall, with a 10.7% rate for surgeries delayed over four days, significant at p = 0.001.
Patients with pre-surgery medical comorbidities had a thirty-day mortality of 17%, hazard ratio = 2.3, p < 0.001.
Surgery delay of up to four days did not significantly affect mortality (p = 0.51).

Study Design

Type

Observational (n=2,660)

Multicenter

Structured PICO

Does a delay in surgery for hip fractures affect postoperative mortality among elderly patients?

Population

2,660 elderly patients who underwent surgical treatment of a hip fracture at one university hospital, followed for up to twelve months.

Exposure

Delay in surgery for hip fractures (1-4 days, >4 days, or delay due to acute medical comorbidities)

Comparator

Surgery without delay

Outcome

Postoperative mortality at 30 days, 90 days, and 12 monthshard clinical

Main Result

Absolute Event Rate: 7.3% vs 8.7%

p-value: p=0.51

Delaying hip fracture surgery up to four days in fit patients does not increase mortality, but delays due to acute medical comorbidities are associated with a 2.5-fold increased risk of 30-day mortality.

Cite This Study

Moran et al. (2005) conducted an observational in hip fracture (n=2,660). Delay in surgery (1 to 4 days) vs. Surgery without delay was evaluated on thirty-day mortality (p=0.51). Delaying hip fracture surgery by 1-4 days did not increase 30-day mortality compared to no delay (7.3% vs 8.7%, p=0.51), but delays >4 days significantly increased 90-day mortality (HR 2.25).

synapsesocial.com/papers/6a6500488451a461f81b89b3 https://doi.org/10.2106/00004623-200503000-00001

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Implication

Delay for medical optimization was not linked to higher mortality; leaves open whether expedited surgery improves survival independent of comorbidities.

Early Mortality After Hip Fracture

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Early Mortality After Hip Fracture

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider