Delay to Surgery and Mortality After Hip Fracture

Rae, Hamish; Harris, Ian A.; McEvoy, Linda; Todorova, Teodora

doi:10.1111/j.1445-2197.2007.04267.x

Cited by 78 publications

(73 citation statements)

References 12 publications

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“…Functional status before fracture, older age, male gender, and higher surgical risk increased the risk of mortality, whereas the use of antibiotics and physical therapy after surgery decreased the risk. Previous studies showed functional status before fracture [14,42,45,52], male gender [12,15,28,33,36,42,47], older age [10,15,28,36,43,47,50,52,55], and higher ASA scores predicted mortality in older patients [24,26,33,44,49] (Table 3), which is in agreement with our findings. In our study, we did not see a difference in mortality between patients undergoing arthroplasty versus patients undergoing osteosynthesis, which is in agreement with mortality reported by Garcia et al [15] and others [18,33,37].…”

Section: Discussionsupporting

confidence: 93%

“…Several studies document comorbid diseases and prefracture health status are associated with the 1-year postfracture mortality [28,46,52], whereas others show no influence of these factors [10,55]. Studies from developed countries suggest preoperative factors increasing the risk of mortality are race (nonwhite) [27,42], old age [10,12,28,52], presence of dementia [24,42], male gender [12,24,33,42], serious concomitant illness [10,12,33,52], low body mass index (BMI) [24], low handgrip strength [37], not walking outdoors before fracture [37], history of hip fracture [4], delirium at admission [9], postoperative complications [46], high preoperative risk score [24,44], and postoperative mobility [25]. In developing countries, orthopaedic services are less available.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

Pereira

Puts

Portela

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Hip fractures in the elderly are common and associated with considerable mortality and disability. Although well known in industrialized countries, the factors associated with mortality after hip fractures are not reported frequently in developing countries and little is known regarding risk factors in Latin America. Questions/PurposeWe investigated the rate of 1-year mortality and prefracture and fracture characteristics associated with mortality after a hip fracture in elderly Brazilian patients in a large metropolitan area. Methods Two hundred forty-six persons 60 years and older admitted to four hospitals in Rio de Janeiro were included after experiencing fractures and were followed for 1 year. Data were collected on sociodemographic, health, and functional status; type of surgery; length of stay; and complications after surgery. Cox regression analyses were conducted to investigate factors associated with 1-year mortality after hip fracture. Results Of the 246 patients, 86 died (35%). Of those 86, 22 died in the hospital (25.6%) and 64 (74.4%) died after discharge. Functional status before fracture, older age, male gender, and higher surgical risk increased the risk of mortality, whereas the use of antibiotics and the use of physical therapy after surgery decreased the risk. Conclusions Our mortality rate was higher than those reported from industrialized countries. The use of antibiotics and physical therapy are potentially modifiable factors to improve patients' survival after fracture in Brazil. Level of Evidence Level II, prognostic study. See the Guidelines for Authors for a complete description of the levels of evidence.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

Pereira

Puts

Portela

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…La mayoría de los trabajos reconocen que una cirugía "temprana" podría tener como punto de corte las primeras 48 horas e influye de una manera positiva en las tasas de mortalidad 15,20,22,[25][26][27][28][29][30][31][32] . Sin embargo, también hay autores que ponen en duda tal aseveración 14,23,33,34 . Existe controversia por tanto acerca de si el retraso en realizar la cirugía en este tipo de fracturas genera más mortalidad, pero lo que sí parece claro es que una cirugía temprana está asociada a un menor número de complicaciones, mejores resultados funcionales, menor estancia hospitalaria y menos reingresos, lo cual indudablemente está asociado a un menor coste 14,35 .…”

Section: Discussionunclassified

Mortalidad y costes asociados a la demora del tratamiento quirúrgico por fractura de cadera

Etxebarría-Foronda

Mar

Arrospide

et al. 2013

Rev. Esp. Salud Publica

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RESUMENFundamentos: La intervención quirúrgica en las fracturas de cadera suele demorarse varios días. Nuestro trabajo tiene dos objetivos. Estudiar la estancia preoperatoria de los pacientes ingresados por fractura de cadera en los hospitales vascos durante el año 2010 y medir su posible asociación con la mortalidad intrahospitalaria, y estimar el coste económico que supone la estancia preoperatoria.Métodos. Se realizó un estudio observacional analizando los siguientes datos del Conjunto Mínimo Básico de Datos (CMBD): hospital, edad, sexo, estancia preoperatoria, estado al alta, diagnósticos asociados y procedimiento quirúrgico. Además, se estudió el índice de comorbilidad de Charlson y se calculó el coste unitario de la estancia pre y postoperatoria mediante modelos de regresión múltiple.Resultados. Se analizó una muestra de 1.856 intervenciones. La estancia preoperatoria fue de 2,7 días y la postoperatoria de 9,7 días. El coste medio por ingreso fue de 12.552,12 euros. El coste medio de la estancia preoperatoria fue de 1295,5 euros. La mortalidad fue del 5%.Conclusiones. La estancia preoperatoria no es un factor estadística-mente asociado con la mortalidad, aunque aumenta significativamente el coste total. No encontramos una asociación entre la demora quirúrgica y la mortalidad, aunque sí tiene una clara influencia en el coste total del proceso. La reducción del tiempo prequirúrgico permite ahorrar costes. Background: Hip fractures surgery is often delayed for several days. The present work has two objectives. The first one is to determine the preoperative hospital length of stay of patients with a hip fracture in our region and its possible correlation with an increase in mortality rate. Secondly we assessed the healthcare expenditure associated to this preoperative period.

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“…Sixteen of these citations proved eligible for inclusion 8,12,15,[22][23][24][25][26][27][28][29][30][31][32][33][34] (Figure 1). Two studies were possible duplicates, but we included both in our analysis because one assessed long-term mortality 24 and the other assessed shortterm mortality.…”

Section: Studies Includedmentioning

confidence: 99%

Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis

Simunovic¹,

Devereaux²,

Sprague³

et al. 2010

Canadian Medical Association Journal

754

502

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Background: Guidelines exist for the surgical treatment of hip fracture, but the effect of early surgery on mortality and other outcomes that are important for patients remains unclear. We conducted a systematic review and meta-analysis to determine the effect of early surgery on the risk of death and common postoperative complications among elderly patients with hip fracture. Methods:We searched electronic databases (including MEDLINE and EMBASE), the archives of meetings of orthopedic associations and the bibliographies of relevant articles and questioned experts to identify prospective studies, published in any language, that evaluated the effects of early surgery in patients undergoing procedures for hip fracture. Two reviewers independently assessed methodologic quality and extracted relevant data. We pooled data by means of the DerSimonian and Laird random-effects model, which is based on the inverse variance method. Results:We identified 1939 citations, of which 16 observational studies met our inclusion criteria. These studies had a total of 13 478 patients for whom mortality data were complete (1764 total deaths). Based on the five studies that reported adjusted risk of death (4208 patients, 721 deaths), irrespective of the cut-off for delay (24, 48 or 72 hours), earlier surgery (i.e., within the cut-off time) was associated with a significant reduction in mortality (relative risk [RR] 0.81, 95% confidence interval [CI] 0.68-0.96, p = 0.01). Unadjusted data indicated that earlier surgery also reduced in-hospital pneumonia (RR 0.59, 95% CI 0.37-0.93, p = 0.02) and pressure sores (RR 0.48, 95% CI 0.34-0.69, p < 0.001).Interpretation: Earlier surgery was associated with a lower risk of death and lower rates of postoperative pneumonia and pressure sores among elderly patients with hip fracture. These results suggest that reducing delays may reduce mortality and complications. AbstractPreviously published at www.cmaj.ca Research Identification of studiesWe used multiple strategies to identify potentially eligible studies. With the help of a professional librarian, we searched the electronic databases MEDLINE and EMBASE for relevant articles in any language that were published up to and including Feb. 8, 2008. The complete search strategies are shown in Appendix 1 (available at www .cmaj .ca /cgi /content /full /cmaj .092220 /DC1). One reviewer (N.S.) also handsearched the archives of annual meetings of the Orthopaedic Trauma Association (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), the International Society of Orthopaedic Surgery and Traumatology (2003-2007), the Canadian Orthopaedic Association (2006)(2007), the European Federation of National Associations of Orthopaedics and Traumatology (2005-2007), the Mid-America Orthopaedic Association (2005, the Piedmont Orthopedic Society (2005Society ( -2007, the Association of Bone and Joint Surgeons (2005-2007) and the American Academy of Orthopaedic Surgeons (2006Surgeons ( -2007 for any relevant unpublished literature. Additiona...

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Delay to Surgery and Mortality After Hip Fracture

Abstract: Our study did not show a significant increase in mortality in patients whose surgery was delayed by more than 2 days. However, in the context of other published work, we would continue to recommend early surgery to minimize length of stay and complications.

Cited by 78 publications

References 12 publications

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

Mortalidad y costes asociados a la demora del tratamiento quirúrgico por fractura de cadera

Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis

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