Influence of preoperative medical status and delay to surgery on death following a hip fracture

Stoddart, Julian; Horne, Geoffrey; Devane, P.

doi:10.1046/j.1445-2197.2002.02425.x

Cited by 43 publications

(38 citation statements)

References 2 publications

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“…Twenty-one of these were excluded, 13 with insufficient data and eight that did not meet our criteria. Thus, five prospective 13-17 and 11 retrospective studies 5,6,[18][19][20][21][22][23][24][25][26] were included in our analysis. One report 17 was excluded from the analysis of 30-day mortality because of possible duplication with another study; 13 but it was included in the analysis of one-year mortality because the other study 13 was not included in this analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Nine trials 6,14,17,18,20,22,23,25,26 (n = 93,391) evaluated one-year mortality with respect to early vs delayed surgery. Mortality occurred in 5,991 of 21,773 patients who underwent delayed surgery and in 16,547 of 71,618 patients who underwent early surgery.…”

Section: Resultsmentioning

confidence: 99%

“…n = number of deaths, N = total number of patients in each group, CI = confidence inter val. spective studies 14,17 was 2.11 (95% CI, 1.46-3.04, Cochran Q statistic = 0.037, P for heterogeneity = 0.85), and that in retrospective studies 6,18,20,22,23,25,26 was 1.33 (95% CI, 1.22-1.44, Cochran Q statistic = 10.9, P for heterogeneity = 0.09).…”

Section: Subgroup and Sensitivity Analysismentioning

confidence: 95%

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Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

Shiga

Wajima

Ohe

2008

Can J Anesth/J Can Anesth

555

338

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Purpose: Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians' guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Methods: Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird randomeffects model. Results:Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI = 1.29-1.54, P < 0.001), and that for one-year mortality was 1.32 (95% CI = 1.21-1.43, P < 0.001). Conclusions: In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Subgroup and Sensitivity Analysismentioning

confidence: 95%

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Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

Shiga

Wajima

Ohe

2008

Can J Anesth/J Can Anesth

555

338

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“…Desde el punto de vista clínico, la comorbilidad de los pacientes aumenta el riesgo de complicaciones y de mortalidad y muchos autores recomiendan su previa estabilización a n t e s d e p r o c e d e r a l a c t o q u i r ú r g ico 12,19,21,39,40 . En nuestra serie llama la atención que la mayoría de los pacientes (67,5%) no tenían ningún tipo de comorbilidad, lo cual, posiblemente, tiene relación con la falta de registro de la comorbilidad en sus infor-mes de alta.…”

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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“…É um sistema amplamente aceito de classifi car o paciente de acordo com o seu risco pré-operatório e utilizado como preditor de resultados, embora não seja considerado um método de ajuste de risco. 10 A classifi cação ASA aparece freqüentemente em estudos sobre a mortalidade após FPF, 11,16,20,23 que mostraram que essa chance de óbito aumenta entre os pacientes com maiores escores. Conforme Stoddart et al, 23 a taxa de mortalidade em 90 dias após a FPF é de 5,3% para pacientes classifi cados como ASA 1 ou 2, e 22,4% para pacientes classifi cados como ASA 3 ou 4.…”

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Aplicação de medidas de ajuste de risco para a mortalidade após fratura proximal de fêmur

et al. 2007

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Influence of preoperative medical status and delay to surgery on death following a hip fracture

Abstract: Time to surgery did not significantly affect 1-year mortality within each ASA Class.

Cited by 43 publications

References 2 publications

Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

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

Aplicação de medidas de ajuste de risco para a mortalidade após fratura proximal de fêmur

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