Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?

Vidal, Edison Iglesias de Oliveira; Moreira-Filho, D. C.; Coeli, Cláudia Medina; Camargo, Kenneth Rochel de; Fukushima, Fernanda Bono; Blais, Régis

doi:10.1007/s00198-008-0757-1

Cited by 25 publications

(15 citation statements)

References 40 publications

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“…Time to surgery is one of the most controversial issues in the hip fracture medical literature(21). Some studies provide evidence that DTS is associated with increased mortality.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Delay to Surgery and Length of Stay for Patients With Hip Fracture

Ricci

Brandt

McAndrew

et al. 2015

Journal of Orthopaedic Trauma

104

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Purpose The purpose of this study was to determine factors, including day of week of hospital admission, associated with delay to surgery (DTS) and increased length of stay (LOS) in patients with hip fractures. Design Retrospective Setting Level I Trauma Center Patients and Methods Six hundred and thirty five consecutive patients admitted to a single hospital between January 1999 and July 2006 age 65 or older with a hip fracture (OTA 31) were identified retrospectively from an orthopaedic database. Demographic data, ASA score, hospital admission and discharge dates, the date of surgery, and details of any pre-operative cardiac testing were extracted from the hospital record. These data were used to identify the day of week for hospital admission and to calculate days for DTS and hospital LOS. Linear regression was used to identify independent variables associated with DTS and increased LOS. Intervention All patients underwent surgical treatment of a hip fracture (OTA 31) Main Outcome Measures Factors effecting DTS and LOS. Results Independent factors associated with DTS included the day of week for hospital admission, ASA score, and the need for pre-operative cardiac testing. Patients admitted Thursday through Saturday had longer DTS (mean 2.2 to 2.7 days) than did patients admitted other days (mean 1.7 – 1.8). Delay to surgery increased for increasing ASA: 1.4 days for ASA 2; 2.0 days for ASA 3; and 3.0 days for ASA 4. Those requiring pre-operative cardiac testing had an increased number of days to surgery (mean 3.2 days) than those without (1.7 days). Independent factors associated with increasing hospital LOS included ASA, the need for pre-operative cardiac testing, male gender, and day of admission. Length of stay increased for increasing ASA: 6.3 days for ASA 2; 8.1 days for ASA 3; and 10.1 days for ASA 4. Those requiring pre-operative cardiac testing had an increased LOS (mean 9.4 days) than those without (7.3 days). Male patients had a longer LOS (mean 9.8 days) than did females (mean 7.3 days). Patients admitted on Thursday or Friday (mean 8.5 – 9.1 days) had longer LOS than those admitted on other days (mean 7.3 – 7.9 days). Conclusions This is the first study to consider and identify day of admission and need for pre-operative cardiac tests as determinants of DTS and LOS for geriatric hip fracture patients. Relative scarcity of weekend hospital resources, when present, may be responsible for these delays. This study also confirms that patient medical condition as measured by ASA affects both DTS and LOS.

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“…Time to surgery is one of the most controversial issues in the hip fracture medical literature(21). Some studies provide evidence that DTS is associated with increased mortality.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Delay to Surgery and Length of Stay for Patients With Hip Fracture

Ricci

Brandt

McAndrew

et al. 2015

Journal of Orthopaedic Trauma

104

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“…Kim et al [14] reported that the operational delay after hospitalization did not affect the incidence of postoperative complications. It was considered by Vidal et al [15,16] that there were no correlations between the length of time from hospitalization to operation and mortality during hospitalization period and 1-year mortality after the operation for patients with brittle hip fracture. However, the length of time from injury to hospitalization is the factor affecting the mortality.…”

Section: Discussionmentioning

confidence: 99%

Effect of time factors on the mortality in brittle hip fracture

Lin

Wang

et al. 2014

Journal of Orthopaedic Surgery and Research

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ObjectiveThe aim of this research is to study the effect of time factors on the mortality of brittle hip fracture.MethodsThe data of 705 patients of hip fracture hospitalized at our department from 2010 to 2012 were reviewed. Among them, 499 cases undergoing surgical operation over the age of 50 were followed up, and 250 cases had valid follow-up records. The effects of the time from injury to operation, the time from injury to hospitalization and the time from hospitalization to operation on the mortality were analyzed.ResultsThe average duration of follow-up was 21.37 ± 9.77 months. There were 198 cases which were followed up for over 12 months. Nine patients died within 3 months after the hip fracture surgery, and 13 patients died within 1 year. A total of 25 patients died during the follow-up. The survival rate of patients with the interval from injury to surgery longer than 5 days was lower than that of patients with the interval less than or equal to 5 days (p = 0.014). The survival rate of patients with the interval from injury to hospitalization longer than 2 days was lower than that of patients with the interval from injury to hospitalization less than or equal to 2 days (p = 0.003). There was no statistical significance in the survival rate between patients with the interval from hospitalization to surgery longer than 3 days and that of patients with the interval from hospitalization to surgery less than or equal to 3 days (p = 0.973).ConclusionThe operational delay, especially the delay of time from injury to hospitalization, is an important factor affecting the early mortality of hip fracture. The delay of time from hospitalization to operation is mainly due to the consideration of the patients' situation and has no effect on early mortality.

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“…More recently, Vidal and coll. (2009), considering that this governmental database system has high standards of internal validity of records, used it as the main data source for their study on mortality related to hip fractures [43].…”

Section: Data Sourcesmentioning

confidence: 99%

Secular trends of hip fractures in Québec, Canada

et al. 2011

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Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?

Abstract: The gap from admission to surgery may be used as a surrogate of the actual delay from fracture to surgery when studying in-hospital HF mortality.

Cited by 25 publications

References 40 publications

Factors Affecting Delay to Surgery and Length of Stay for Patients With Hip Fracture

Factors Affecting Delay to Surgery and Length of Stay for Patients With Hip Fracture

Effect of time factors on the mortality in brittle hip fracture

Secular trends of hip fractures in Québec, Canada

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