Isolated hip fracture in the elderly and time to surgery: is there an outcome difference?

Elkbuli, Adel; Eily, Alyssa; Polcz, Valerie; Boneva, Dessy; Spano, Paul J.; McKenney, Mark; Hai, Shaikh

doi:10.1136/tsaco-2018-000212

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…In terms of surgical delay, if the surgery is performed after 48 hours of hospitalization, the mortality rate at 3 and 12 months after surgery for hip fracture in elderly patients increases [ 21 ]. Conversely, other studies have shown no effect on mortality within 30 days [ 22 ]. However, there is still no agreement on the relationship between early hip fracture surgery and postoperative mortality [ 23 ].…”

Section: Discussionmentioning

confidence: 95%

Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

et al. 2023

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Summary We investigated the risk factors for mortality of hip fracture in the elderly using the National Database of Health Insurance Claims in Japan, and survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. Purpose Hip fracture is the most common fracture in the elderly and is known to have a high mortality rate. In Japan, to the best of our knowledge, no studies have reported on mortality risk factors for hip fracture using nationwide registry databases. This study aimed to determine the number of occurrences of hip fracture and factors that increase mortality using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Methods This study included extracted data from patients who were hospitalized and underwent surgical treatment for hip fracture between 2013 and 2021, using a nationwide health insurance claims database in Japan. Patient characteristics, such as sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism, were tabulated to obtain 1-year and in-hospital mortality rates. Results Both 1-year and in-patient survival were significantly lower in men, older patients, patients who underwent surgery after 3 days of admission, and patients with trochanteric and subtrochanteric fractures, internal fixation, more preoperative comorbidities, blood transfusions, and pulmonary embolism. Conclusions Survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. As the number of male patients with hip fracture will increase with the aging of society, medical staff must provide sufficient information before surgery to avoid postoperative mortality.

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Section: Discussionmentioning

confidence: 95%

Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

et al. 2023

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“…However, a review of the literature yielded conflicting results on the association between mortality and timing of surgery. 11–13…”

Section: Discussionmentioning

confidence: 99%

“…7 To reduce mortality and morbidity, early operative intervention for hip fractures in the elderly is advised. 8,9 The primary goals of this study were to evaluate the mortality rates at 3 and 12 months after hip fracture repair surgery in a medical center where a large number of these procedures are performed, and to assess the association between various demographic and clinical variables and increased postoperative mortality.…”

Section: Introductionmentioning

confidence: 99%

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Mortality following surgery for geriatric hip fractures: is it the timing or the co-morbidities?

et al. 2020

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Background: Hip fractures are prevalent in the elderly population and present serious health, social and economic problems, with an impact on morbidity and mortality. Today, it is common practice to surgically repair these fractures as early as possible, preferably within 48 hours of hospital admission. However, there is conflicting evidence in the literature about the effect of the timing of surgery on postoperative mortality. Objectives: To assess the association between surgery delay and other demographic and clinical variables with an increased mortality rate after surgical treatment of hip fractures in the elderly. Methods: A retrospective study was conducted on patients aged ⩾65 years with a primary diagnosis of hip fracture. All patients underwent surgery in our Medical Center from 2015 to 2017. A multivariate model of logistic regression, Cox regression model and Kaplan-Meier survival analysis were used to evaluate the relationship between various variables and mortality rates at 3- and 12-month follow-ups. Results: A total of 877 patients were included, 30% were men and 70% women; the mean age was 83.3 years. Multivariate analysis showed that mortality was significantly higher among patients who underwent late surgery, after adjusting for gender, age, co-morbidity, age of surgeon, duration of surgery and duration of hospitalisation ( p = 0.030). Surgical delay was significantly associated with higher mortality rates both at 3 month ( p = 0.041) and at 12 months after surgery ( p = 0.013). The presence of ischemic heart disease, congestive heart failure, paroxysmal atrial fibrillation and chronic renal failure, as well as male gender and older age, were also significantly associated with higher early and late mortality. Conclusions: In elderly patients, hip fracture surgery should be performed within 48 hours of admission. Male and older patients, as well as patients with the aforementioned co-morbidities, are at higher risk of mortality at 3 and 12 months after surgery.

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“…3 Timely surgical intervention of an isolated hip fracture is beneficial and results in decreases in mortality, postoperative complications, and health care costs. 4 Comorbidities in the elderly are common and may complicate the treatment of isolated hip fractures. The main objective of our study was to evaluate the risk factors for morbidity and mortality in the setting of isolated hip fractures in the elderly with secondary analyses including impact of comorbidity, prior advanced directive, functional dependence prior to isolated hip fracture, and factors associated with hospital length stay, increased ICU admission, and disposition.…”

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confidence: 99%

Isolated Hip Fractures in the Elderly: Best Practice Analysis of Perioperative Medical Optimization Including Effect of Comorbidities, Functional Status, and Demographics

Rhodes

Coile

Eversley-Kelso

et al. 2022

The American Surgeon

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Isolated hip fractures (IHFs) contribute to functional decline in the elderly. Our purpose was to evaluate IHF at two level 1 trauma centers and the effect of comorbidities on length of stay (LOS), ICU admission, disposition, and mortality. A retrospective study from July 2016 through December 2020 including patients ≥65 with IHFs identified 785 patients. Prior dependent functional status yielded a longer LOS (>6 days vs <6 days, P = .01). Comorbidities were not associated with increased LOS or ICU admission. ICU admission rate was 12.75%. Patients with advanced directive had increased ICU admission (8% vs 3%). The mortality rate was 2%. Increased mortality was seen with advanced directives (17% vs 2%, P < .05) and cirrhosis/substance abuse (12% vs 2%, P < .05). Disposition included home (20%), rehabilitation (43%), and SNF (31%). Comorbidities did not affect ICU admission, LOS, or disposition; however, cirrhosis/substance abuse demonstrated increased mortality.

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Isolated hip fracture in the elderly and time to surgery: is there an outcome difference?

Cited by 8 publications

References 16 publications

Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

Mortality following surgery for geriatric hip fractures: is it the timing or the co-morbidities?

Isolated Hip Fractures in the Elderly: Best Practice Analysis of Perioperative Medical Optimization Including Effect of Comorbidities, Functional Status, and Demographics

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