Morbidity and mortality after hip fracture: the impact of operative delay

Gdalevich, Michael; Cohen, Dani; Yosef, Dina; Tauber, C.

doi:10.1007/s00402-004-0662-9

Cited by 163 publications

(24 citation statements)

References 33 publications

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“…Similar findings were also reported from Casaletto and Gatt [18], Zuckerman et al [19], and Elliott et al [20]. Gdalevich et al [21] reported their results of 651 patients and found early surgery within 48 h was associated with improved 1-year mortality. Since the premorbid status and pre-existing co-morbidities of the patients will also affect mortality, there have been attempts to classify patients as ‘fit for surgery’ and ‘with medical co-morbidities’.…”

Section: Resultssupporting

confidence: 82%

Does timing of surgery matter in fragility hip fractures?

et al. 2010

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The effect of delay of surgery on the geriatric hip fractures has been a subject of interest in the past two decades. While the elderly patients will not tolerate long periods of immobilization, it is still unclear how soon these surgeries need to be performed. A review of existing literature was performed to examine the effect of timing of surgery on the different outcome parameters of these patients. Although there is conflicting evidence that early surgery would improve mortality, there is widespread evidence in the literature that other outcomes including morbidity, the incidence of pressure sores, and the length of hospital stay could be improved by shortening the waiting time of hip fracture surgery. We concluded that it is beneficial to the elderly patients to receive surgical treatment as an urgent procedure as soon as the body meets the basic anesthetic requirements.

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Section: Resultssupporting

confidence: 82%

Does timing of surgery matter in fragility hip fractures?

et al. 2010

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“…The mortality rates in our study exceed other estimates previously reported [1]; [7]; [8]; [14]; [28]. This might be due to the non-selected patient population including some patients with multiple co-existing diseases.…”

Section: Discussioncontrasting

confidence: 59%

“…The majority of the patients (87%) in our assessment underwent surgery within 48 hours after admission. Hereby, our patient population differs from most other studies, where the interval of surgical delay was wider [1]; [8]; [12]; [13]; [16]; [28], making them difficult to compare. As an example, patients who in other studies would have been delayed for medical reasons, might have been included in the <48 hours group of our study.…”

Section: Discussionmentioning

confidence: 93%

Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

et al. 2014

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ObjectiveIn hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and ‘length of hospital stay’, ‘priority of surgery’, ‘time of surgery’, or ‘surgical delay’ in hip fracture surgery.DesignObservational cohort study.SettingProspectively and consecutively reported data from the Danish Anaesthesia Database were linked to The Danish National Registry of Patients and The Civil Registration System. Records on vital status, admittance, discharges, codes of diagnosis, anaesthetic and surgical procedures were retrieved.Participants6143 patients aged more than 65 years undergoing hip fracture surgery.Main Outcome MeasuresAll-cause mortality.ResultsThe one year mortality was 30% (28–31%, 95% Confidence interval (CI)). In a multivariate model ‘length of hospital stay’ less than 10 days and more than 20 days are associated with mortality with hazard ratios of 1.34 (1.20–1.53 CI, p<0.001) and 1.27 (1.06–1.51 CI, p<0.001), respectively. ‘Priority of surgery’ categorized as ‘non-scheduled’ is associated with mortality with a hazard ratio of 1.31 (1.13–1.50 CI, p<0.001). Surgical delay and time of surgery are not significantly associated with mortality.ConclusionNon-scheduled surgery and length of hospital stay were associated with increased mortality. Confounding by indication may bias observational studies evaluating early and late discharge as well as priority; therefore cluster randomized clinical trials comparing different clinical set ups may be warranted evaluating health care organizational factors.

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“…A number of studies have identified early surgical intervention as a significant prognostic factor in outcomes for patients presenting with hip fractures. 25-27 It was not feasible to accurately measure time to medical clearance in this investigation, but we believe that preoperative medical optimization has improved with the OHC, allowing us to expedite operative intervention. Having the patients admitted to the orthopedic floor provides access to physical therapists who routinely work exclusively with orthopedic patients and accelerate discharge planning.…”

Section: Discussionmentioning

confidence: 94%

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

Bracey

Kiymaz

Holst

et al. 2016

Geriatr Orthop Surg Rehabil

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Introduction:Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States, representing a health-care cost of US$9 to 20 billion. Hip fracture incidence is projected to increase dramatically. Hospitals must modify clinical models to accommodate this growing burden. Comanagement strategies are reported in the literature, but few have addressed orthopedic-hospitalist models. An orthopedic-hospitalist comanagement (OHC) service was established at our hospital to manage hip fracture patients. We sought to determine whether the OHC (1) improves the efficiency of hip fracture management as measured by inpatient length of stay (LOS) and time to surgery (TTS) and (2) whether our results are comparable to those reported in hip fracture comanagement literature.Methods:A comparative retrospective–prospective cohort study of patients older than 60 years with an admitting diagnosis of hip fracture was conducted to compare inpatient LOS and TTS for hip fracture patients admitted 10 months before (n = 45) and 10 months after implementation (n = 54) of the OHC at a single academic hospital. Secondary outcome measures included percentage of patients taken to surgery within 24 or 48 hours, 30-day readmission rates, and mortality. Outcomes were compared to comanagement study results published in MEDLINE-indexed journals.Results:Patient cohort demographics and comorbidities were similar. Inpatient LOS was reduced by 1.6 days after implementation of the OHC (P = .01) without an increase in 30-day readmission rates or mortality. Time to surgery was insignificantly reduced from 27.4 to 21.9 hours (P = .27) and surgery within 48 hours increased from 86% to 96% (P = .15).Discussion:The OHC has improved efficiency of hip fracture management as judged by significant reductions in LOS with a trend toward reduced TTS at our institution.Conclusion:Orthopedic-hospitalist comanagement may represent an effective strategy to improve hip fracture management in the setting of a rapidly expanding patient population.

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Morbidity and mortality after hip fracture: the impact of operative delay

Abstract: These findings suggest that early (within 48 h) surgical treatment of hip fractures is associated with improved 1-year survival.

Cited by 163 publications

References 33 publications

Does timing of surgery matter in fragility hip fractures?

Does timing of surgery matter in fragility hip fractures?

Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

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