TY - JOUR
T1 - Influence of time to surgery on clinical outcomes in elderly hip fracture patients
T2 - an assessment of surgical postponement due to non-medical reasons
AU - van Rijckevorsel, Veronique A.J.I.M.
AU - de Jong, Louis
AU - Dutch Hip Fracture Registry Collaboration
AU - Verhofstad, Michael H.J.
AU - Roukema, Gert R.
N1 - Funding Information:
The authors choose not to disclose receipt of any financial or material support for the research, authorship, and/or publication of this article.
Publisher Copyright:
© 2022 Author(s) et al.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - AIMS: Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize clinical outcomes after hip fracture surgery. This study aims to determine the influence of postponement of surgery due to non-medical reasons on clinical outcomes in acute hip fracture surgery. METHODS: This observational cohort study enrolled consecutively admitted patients with a proximal femoral fracture, for which surgery was performed between 1 January 2018 and 11 January 2021 in two level II trauma teaching hospitals. Patients with medical indications to postpone surgery were excluded. A total of 1,803 patients were included, of whom 1,428 had surgery < 24 hours and 375 had surgery ≥ 24 hours after admission. RESULTS: Prolonged total length of stay was found when surgery was performed ≥ 24 hours (median 6 days (interquartile range (IQR) 4 to 9) vs 7 days (IQR 5 to 10); p = 0.001) after admission. No differences in postoperative length of hospital stay nor in 30-day mortality rates were found. In subgroup analysis for time frames of 12 hours each, pressure sores and urinary tract infections were diagnosed more frequently when time to surgery increased. CONCLUSION: Longer time to surgery due to non-medical reasons was associated with a higher incidence of postoperative pressure sores and urinary tract infections when time to surgery was more than 48 hours after admission. No association was found between time to surgery and 30-day mortality rates or postoperative length of hospital stay.Cite this article: Bone Joint J 2022;104-B(12):1369-1378.
AB - AIMS: Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize clinical outcomes after hip fracture surgery. This study aims to determine the influence of postponement of surgery due to non-medical reasons on clinical outcomes in acute hip fracture surgery. METHODS: This observational cohort study enrolled consecutively admitted patients with a proximal femoral fracture, for which surgery was performed between 1 January 2018 and 11 January 2021 in two level II trauma teaching hospitals. Patients with medical indications to postpone surgery were excluded. A total of 1,803 patients were included, of whom 1,428 had surgery < 24 hours and 375 had surgery ≥ 24 hours after admission. RESULTS: Prolonged total length of stay was found when surgery was performed ≥ 24 hours (median 6 days (interquartile range (IQR) 4 to 9) vs 7 days (IQR 5 to 10); p = 0.001) after admission. No differences in postoperative length of hospital stay nor in 30-day mortality rates were found. In subgroup analysis for time frames of 12 hours each, pressure sores and urinary tract infections were diagnosed more frequently when time to surgery increased. CONCLUSION: Longer time to surgery due to non-medical reasons was associated with a higher incidence of postoperative pressure sores and urinary tract infections when time to surgery was more than 48 hours after admission. No association was found between time to surgery and 30-day mortality rates or postoperative length of hospital stay.Cite this article: Bone Joint J 2022;104-B(12):1369-1378.
UR - http://www.scopus.com/inward/record.url?scp=85143114401&partnerID=8YFLogxK
U2 - 10.1302/0301-620X.104B12.BJJ-2022-0172.R2
DO - 10.1302/0301-620X.104B12.BJJ-2022-0172.R2
M3 - Article
C2 - 36453044
AN - SCOPUS:85143114401
SN - 2049-4394
VL - 104-B
SP - 1369
EP - 1378
JO - The bone & joint journal
JF - The bone & joint journal
IS - 12
ER -