Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis

Klestil, Thomas; Röder, Christoph; Stotter, Christoph; Winkler, Birgit; Nehrer, Stefan; Lutz, M.; Klerings, Irma; Wagner, Gernot; Gartlehner, Gerald; Nußbaumer-Streit, Barbara

doi:10.1038/s41598-018-32098-7

Cited by 275 publications

(242 citation statements)

References 64 publications

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“…The ITF mortality rate has been associated with anemia and surgical delay [29,30]. The appropriate time for ITF surgery is within 24 to 72 h of the occurrence of trauma [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

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Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Lin

Chien

Hung

et al. 2020

BMC Musculoskelet Disord

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Background: With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop. Methods: Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre-and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and the use of anticoagulants. Results: Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p < 0.05). Conclusions: Patients with unstable ITFs exhibited a greater hemoglobin drop and a hidden blood loss was suspected around the fracture site. We believe that this should be taken into consideration when presurgical blood transfusion is being planned for patients with unstable ITFs, to reduce associated postoperative complications, especially in patients with severe anemia or high risk of mortality.

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“…The ITF mortality rate has been associated with anemia and surgical delay [29,30]. The appropriate time for ITF surgery is within 24 to 72 h of the occurrence of trauma [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

“…The appropriate time for ITF surgery is within 24 to 72 h of the occurrence of trauma [31][32][33]. Surgery within 48 h of admission after ITF will reduce the length of hospital stay, mortality rate, and perioperative complications [29,30]. If the length of time between admission and surgery is > 24 h, patients will have lower blood loss.…”

Section: Discussionmentioning

confidence: 99%

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Lin

Chien

Hung

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…The ITF mortality rate has been associated with anemia and surgical delay (28,29). The appropriate time for ITF surgery is within 24 and 72 hours of the occurrence of trauma (30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

“…The appropriate time for ITF surgery is within 24 and 72 hours of the occurrence of trauma (30)(31)(32). Surgery within 48 hours of admission after ITF will reduce the hospital stay, mortality rate, and perioperative complications (28,29). If the length of time between admission and surgery is > 24 hours, patients will have lower blood loss.…”

Section: Discussionmentioning

confidence: 99%

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Lin

Chien

Hung

et al. 2019

Preprint

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“…Early surgery may reduce the risk for complications like pressure sores, wound infections, pneumonias and persistent pain . However, the available mortality studies are inconsistent and it has been debated if time‐to‐surgery per se effect mortality and if so, at what time limit does mortality rate increase …”

Section: Introductionmentioning

confidence: 99%

The influence of time‐to‐surgery on mortality after a hip fracture

Kristiansson

Hagberg

Nellgård

2019

Acta Anaesthesiol Scand

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Background The effect of time‐to‐surgery on mortality in acute hip fracture (AHF) patients has been debated and studies are inconsistent regarding from what time limit mortality starts to increase. At Sahlgrenska University Hospital/Mölndal, surgery is recommended within 24 hours leaving little time for pre‐operative optimization. However, internationally the definition of early surgery varies between 24 and 48 hours and over. This retrospective study was initiated to investigate the relation between time‐to‐surgery and 30‐day mortality. Method Data of AHF patients from January 2007 through December 2016 were collected. The variables analysed were: age, gender, American Society of Anesthesiologists physical status classification, surgical method (prosthesis or osteosynthesis) and time‐to‐surgery, along with 30‐day mortality. Primary outcome was 30‐day mortality related to time‐to‐surgery divided into groups. Secondary outcome was 30‐day mortality related to time‐to‐surgery analysed hour‐by‐hour. Results From 10,844 eligible patients, 9,270 patients were included into the study. Mean time‐to‐surgery was 19.4 hours and overall 30‐day mortality was 7.6%. Adjusted Cox regression analysis revealed an increased mortality rate in patients with time‐to‐surgery >48 hours. In the hour‐by‐hour analysis, significant mortality increase was observed at 39 hours of time‐to‐surgery. Patients with time‐to‐surgery >24 hours did not have increased mortality compared to patients with time‐to‐surgery <24 hours. Conclusion In AHF patients, a time‐to‐surgery exceeding 39‐48 hours was associated with increased mortality. Patients with surgeries performed before 39‐48 hours did not have increased mortality and this time may, in some patients, be used for optimization prior surgery even if time‐to‐surgery exceeds 24 hours.

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Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis

Cited by 275 publications

References 64 publications

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study

The influence of time‐to‐surgery on mortality after a hip fracture

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