48 h for femur fracture treatment: are we choosing the wrong quality index?

Aprato, Alessandro; Casiraghi, Alessandro; Pesenti, Giovanni; Bechis, Marco; Samuelly, Alessandro; Galante, Claudio; Capitani, Dario; Massè, Alessandro

doi:10.1186/s10195-019-0518-2

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…As shown in a previous study [10], our results suggest that the probability of walking again after the surgery is not only influenced by surgical timing but also by ASA score. In fact, comorbidities [5] may influence mortality after a femoral fracture.…”

Section: Discussionsupporting

confidence: 85%

“…Literature have strongly demonstrated a significant correlation between early surgical treatment and mortality. However, recent studies have showed that early surgical intervention without prompt mobilization and weight bearing did not seem sufficient to reduce the hospitalization and recovery time [10,11]. Our study suggests that, without early ambulation, mortality rates increase in femur fracture patients.…”

Section: Discussionmentioning

confidence: 49%

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No rest for elderly femur fracture patients: early surgery and early ambulation decrease mortality

et al. 2020

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Background: Literature has shown a significant correlation between early treatment and mortality in femur fractures, but the influence of time to ambulation on mortality has not been studied. The purpose of the present study is to evaluate whether time to ambulation is correlated to femur fracture mortality independently from time to surgery. Patients and methods: All patients older than 65 years admitted at a level I trauma center with proximal femoral fracture during a 1-year period were included. The following data were collected: age, gender, date and time of admission to emergency department, height, weight, body mass index, type and side of fracture, ASA score, date and time of surgery, surgical time, time to ambulation, length of hospitalization, death during hospitalization, and mortality at 6 and 12 months. Results: The study sample comprises 516 patients. The mean age was 83.6 years; ASA score was 3-5 in 53% of patients; 42.7% presented with medial fracture; mean time between admission and surgery was 48.4 h; 22.7% of patients were not able to walk during the first 10 days after fracture; mean duration of hospitalization was 13 days; and mortality was 17% at 6 months and 25% at 1 year. Early surgery and walking ability at 10 days after trauma were independently and significantly associated with mortality at 6 months (p = 0.014 and 0.002, respectively) and at 1 year (0.027 and 0.009, respectively). Conclusions: Early surgery in femur fracture became a priority in health systems, but early postoperative physiotherapy also plays a major role in prevention of mortality: independently from surgical timing, patients who did not walk again within 10 days from surgery showed mortality rates higher than those of patients who did. Level of evidence: IV.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 49%

No rest for elderly femur fracture patients: early surgery and early ambulation decrease mortality

et al. 2020

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“…Delay in surgery may increase complications such as pain, myocardial infarction due to increased sympathetic activity, embolism, atelectasis, and infection. 20,21 In our study, when the time from fracture to surgery was analysed, no statistically significant difference was found between patients hospitalised in the intensive care unit and in the ward. The length of surgical time has been reported as a risk factor that increases the risk of complications and blood transfusion.…”

Section: Discussioncontrasting

confidence: 55%

A retrospective analysis of postoperative geriatric patients with hip fracture; the reasons for admission to ICU

Babayiğit,

Honca,

Bayraktaroğlu

et al. 2024

KMJ

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Aims: : Geriatric patients with hip fracture experience high rates of mortality and morbidity. The purpose of this study was to analyse the epidemiology, complications and reasons for admission to ICU of the postoperative geriatric patients undergoing hip fracture surgery. Methods: Patients aged 60 years and over who were operated on for hip fractures were retrospectively examined. Demographic characteristics, type of anesthesia (general/regional), operation time, and complications were recorded from the patients' files. Results: The median age of the patients included in the study was 78.9±8.39 (min 60-max 100). It was observed that 71.6% of the patients were women, 13 patients received general anesthesia, and the rest received regional anesthesia. It was determined that 56.2% of the patients were admitted to intensive care. It was found that the surgery duration of patients admitted to intensive care was longer, and their average age and ASA scores were higher. Conclusion: In our study, besides to the development of perioperative complications, age >80 years, ASA score 3 and 4, and long operation time were found to be the most important factors that required patients to be admitted to intensive care.

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“…As early surgery for proximal femoral fractures became a priority in health systems, they emphasized early postoperative physiotherapy to play an important role in reducing mortality. Independent of time for surgery, they were able to prove that patients who did not walk again within 10 days after surgery had a higher mortality [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Early surgery? In-house mortality after proximal femoral fractures does not increase for surgery up to 48 h after admission

et al. 2023

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Purpose The economic cost linked to the increasing number of proximal femur fracture and their postoperative care is immense. Mortality rates are high. As early surgery is propagated to lower mortality and reduce complication rates, a 24-h target for surgery is requested. It was our aim to determine the cut-off for the time to surgery from admission and therefore establish a threshold at which the in-house mortality rate changes. Methods A retrospective single-center cohort study was conducted including 1796 patients with an average age of 82.03 years treated operatively for a proximal femoral fracture between January 2016 and June 2020. A single treatment protocol was performed based on the type of anticoagulant, surgery, and renal function. Patient data, surgical procedure, time to surgery, complications, and mortality were assessed. Results In-house mortality rate was 3.95%, and the overall complication rate was 22.7%. A prolonged length of hospital stay was linked to patient age and occurrence of complications. Mortality is influenced by age, number of comorbidities BMI, and postoperative complications of which the most relevant is pneumonia. The mean time to surgery for the entire cohort was 26.4 h. The investigation showed no significant difference in mortality rate among the two groups treated within 24 h and 24 to 48 h while comparing all patients treated within 48 h and after 48 h revealed a significant difference in mortality. Conclusions Age and number of comorbidities significantly influence mortality rates. Time to surgery is not the main factor influencing outcome after proximal femur fractures, and mortality rates do not differ for surgery up to 48 h after admission. Our data suggest that a 24-h target is not necessary, and the first 48 h may be used for optimizing preoperative patient status if necessary.

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48 h for femur fracture treatment: are we choosing the wrong quality index?

Cited by 5 publications

References 18 publications

No rest for elderly femur fracture patients: early surgery and early ambulation decrease mortality

No rest for elderly femur fracture patients: early surgery and early ambulation decrease mortality

A retrospective analysis of postoperative geriatric patients with hip fracture; the reasons for admission to ICU

Early surgery? In-house mortality after proximal femoral fractures does not increase for surgery up to 48 h after admission

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