Mortality effects of timing alternatives for hip fracture surgery

Guy, Pierre; Sobolev, Boris; Kuramoto, Lisa; Sutherland, Jason M.; Levy, Adrian R.; Blair, James A.; Bohm, Éric; Kim, Jason D.; Harvey, Edward J.; Morin, Suzanne N; Beaupré, Lauren A; Dunbar, Michael J.; Jaglal, Susan; Waddell, James P.

doi:10.1503/cmaj.171512

Cited by 51 publications

(38 citation statements)

References 51 publications

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“…This is also supported by a study from Canada demonstrating that a shorter LOS was related to worse quality‐of‐care. Furthermore, when analysing long‐term mortality there may be increased risk of complications not associated with the hip fracture and therefore 30‐day mortality was analysed.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…All the osteosynthesis was conducted on a radiolucent traction table under real-time uoroscopic examination throughout the surgical procedure. We used the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classi cation as the reference to determine a "stable" or "unstable" femoral intertrochanteric fracture 9,18 . According to the AO classi cation, type 31-A1.1, 1.2, 1.3, and 2.1 were classi ed as stable fracture patterns while the rest types of 31-A were classi ed as unstable ones.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Multiple comorbidities result in high rates of morbidity and mortality, which makes intertrochanteric fractures challenging to treat for orthopedic surgeons [4][5][6]. Early surgical xation on these aging patients has been proposed recently for early rehabilitation and has had a positive impact on reducing comorbidities [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries

Yeh

Liu

Chou

et al. 2020

Preprint

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Background: The center-center lag screw position has been widely accepted as the optimal lag screw/helical blade position in femoral intertrochanteric fracture surgery to achieve a tip-apex distance (TAD) less than 25 mm. Despite the inferior-center lag screw/helical blade position having some biomechanical advantages, and the emergence of calcar-referenced tip-apex distance (CalTAD), the clinical differences between the two commonly placed lag screw/helical blade positions remain unclear. This study aimed to (1) report radiological outcomes in managing geriatric femoral intertrochanteric fractures, (2) identify the influences of positions of lag screw/helical blade, and (3) identify the relationship between implants and the values of TAD and CalTAD.Methods: We retrospectively assessed the clinical and radiographic findings of geriatric patients (age ≥ 55 years) who underwent surgery for acute closed femoral intertrochanteric fractures during 1-year period and were followed up a minimum of 6 months. The radiographic parameters and incidences of fixation failure were compared between the different lag screw and helical blade positions (center-center vs. inferior-center). Subgroup analyses of different implant types (extramedullary and intramedullary) were also performed for comparisons for different lag screw positions, and TAD and CalTAD beyond the normal standard value of 25 mm.Results: A total of 206 patients were included during the study period, with a 7.8% fixation failure. There were no differences in incidences of fixation failure between the commonly inserted lag screw/helical blade positions (center-center vs. inferior-center), regardless of the implant types. Those with a TAD > 25 mm had significantly higher incidence of fixation failure than those with a TAD ≤ 25 mm in the extramedullary plate (17.0% vs. 1.2%, p = 0.001), but not in the intramedullary nails (16.1% vs. 4.4%, p = 0.08). There were no significant differences in incidences of fixation failure between CalTAD ≤ 25 mm and CalTAD > 25 mm in either extramedullary or intramedullary implants. Conclusion: Although TAD > 25 mm might increase the fixation failure rate in extramedullary plates, an inferior-center lag screw/helical blade position could achieve comparable radiographic results as a center-center position after osteosynthesis for geriatric femoral intertrochanteric fractures.

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“…Access to care can be characterized by the timely delivery of appropriate care to achieve the best health outcomes [5]. Indeed, expeditious surgical repair is shown to reduce the risk of major perioperative complications, 6% vs 8%, [6] and inhospital death, 5% vs 7% [7].…”

Section: Introductionmentioning

confidence: 99%

Variation in surgical demand and time to hip fracture repair: a Canadian database study

Kim

Beaupré

Bohm³

et al. 2020

BMC Health Serv Res

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Background Competing demands for operative resources may affect time to hip fracture surgery. We sought to determine the time to hip fracture surgery by variation in demand in Canadian hospitals. Methods We obtained discharge abstracts of 151,952 patients aged 65 years or older who underwent surgery for a hip fracture between January, 2004 and December, 2012 in nine Canadian provinces. We compared median time to surgery (in days) when demand could be met within a two-day benchmark and when demand required more days, i.e. clearance time, to provide surgery, overall and stratified by presence of medical reasons for delay. Results For persons admitted when demand corresponded to a 2-day clearance time, 68% of patients underwent surgery within the 2-day benchmark. When demand corresponded to a clearance time of one week, 51% of patients underwent surgery within 2 days. Compared to demand that could be served within the two-day benchmark, adjusted median time to surgery was 5.1% (95% confidence interval [CI] 4.1–6.1), 12.2% (95% CI 10.3–14.2), and 22.0% (95% CI 17.7–26.2) longer, when demand required 4, 6, and 7 or more days to clear the backlog, respectively. After adjustment, delays in median time to surgery were similar for those with and without medical reasons for delay. Conclusion Increases in demand for operative resources were associated with dose-response increases in the time needed for half of hip fracture patients to undergo surgery. Such delays may be mitigated through better anticipation of day-to-day supply and demand and increased response capability.

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Mortality effects of timing alternatives for hip fracture surgery

Abstract: The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay.

Cited by 51 publications

References 51 publications

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

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

Similarities between Inferior-Center and Center-Center Lag Screw Positions in Femoral Intertrochanteric Fracture Surgeries

Variation in surgical demand and time to hip fracture repair: a Canadian database study

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