Proximal Femoral Fractures in the Elderly: Does Operative Delay for Medical Reasons Affect Short-term Outcome?

Harries, D. J.; Eastwood, H.

doi:10.1093/ageing/20.1.41

Cited by 14 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Harries and Eastwood specifically looked into post-operative length of stay and could not identified any relationship with surgeries done within 24 h [42]. Ho et al also revealed the waiting time for surgery was not a significant predictor of post-surgery length of stay when confounding factors were controlled [43].…”

Section: Resultsmentioning

confidence: 99%

Does timing of surgery matter in fragility hip fractures?

et al. 2010

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Does timing of surgery matter in fragility hip fractures?

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Sixteen of these citations proved eligible for inclusion 8,12,15,[22][23][24][25][26][27][28][29][30][31][32][33][34] (Figure 1). Two studies were possible duplicates, but we included both in our analysis because one assessed long-term mortality 24 and the other assessed shortterm mortality.…”

Section: Studies Includedmentioning

confidence: 99%

“…We judged four studies 8,[32][33][34] to be of high methodologic quality, five studies 15,22,24,27,31 to be of moderate quality and the remaining seven studies 12,23,25,26,[28][29][30] to be of low quality (Table 1). Agreement between reviewers in the assessment of study quality was excellent (intraclass correlation coefficient 0.92, 95% CI 0.75-0.97).…”

Section: Study Qualitymentioning

confidence: 99%

Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis

Simunovic¹,

Devereaux²,

Sprague³

et al. 2010

Canadian Medical Association Journal

752

502

View full text Add to dashboard Cite

Background: Guidelines exist for the surgical treatment of hip fracture, but the effect of early surgery on mortality and other outcomes that are important for patients remains unclear. We conducted a systematic review and meta-analysis to determine the effect of early surgery on the risk of death and common postoperative complications among elderly patients with hip fracture. Methods:We searched electronic databases (including MEDLINE and EMBASE), the archives of meetings of orthopedic associations and the bibliographies of relevant articles and questioned experts to identify prospective studies, published in any language, that evaluated the effects of early surgery in patients undergoing procedures for hip fracture. Two reviewers independently assessed methodologic quality and extracted relevant data. We pooled data by means of the DerSimonian and Laird random-effects model, which is based on the inverse variance method. Results:We identified 1939 citations, of which 16 observational studies met our inclusion criteria. These studies had a total of 13 478 patients for whom mortality data were complete (1764 total deaths). Based on the five studies that reported adjusted risk of death (4208 patients, 721 deaths), irrespective of the cut-off for delay (24, 48 or 72 hours), earlier surgery (i.e., within the cut-off time) was associated with a significant reduction in mortality (relative risk [RR] 0.81, 95% confidence interval [CI] 0.68-0.96, p = 0.01). Unadjusted data indicated that earlier surgery also reduced in-hospital pneumonia (RR 0.59, 95% CI 0.37-0.93, p = 0.02) and pressure sores (RR 0.48, 95% CI 0.34-0.69, p < 0.001).Interpretation: Earlier surgery was associated with a lower risk of death and lower rates of postoperative pneumonia and pressure sores among elderly patients with hip fracture. These results suggest that reducing delays may reduce mortality and complications. AbstractPreviously published at www.cmaj.ca Research Identification of studiesWe used multiple strategies to identify potentially eligible studies. With the help of a professional librarian, we searched the electronic databases MEDLINE and EMBASE for relevant articles in any language that were published up to and including Feb. 8, 2008. The complete search strategies are shown in Appendix 1 (available at www .cmaj .ca /cgi /content /full /cmaj .092220 /DC1). One reviewer (N.S.) also handsearched the archives of annual meetings of the Orthopaedic Trauma Association (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), the International Society of Orthopaedic Surgery and Traumatology (2003-2007), the Canadian Orthopaedic Association (2006)(2007), the European Federation of National Associations of Orthopaedics and Traumatology (2005-2007), the Mid-America Orthopaedic Association (2005, the Piedmont Orthopedic Society (2005Society ( -2007, the Association of Bone and Joint Surgeons (2005-2007) and the American Academy of Orthopaedic Surgeons (2006Surgeons ( -2007 for any relevant unpublished literature. Additiona...

show abstract

“…There is a reduced incidence of avascular necrosis of the femoral head and nonunion, morbidity and mortality, and of complications including decubitus ulcers, urinary tract infections, and deep vein thrombosis (DVT). [15][16][17][18][19][20][21][22][23][24][25] However, the data about mortality in this group of patients is conflicting. In a retrospective study of 6638 patients with a fracture of the hip, Bretherton and Parker 19 found that surgery 12 hours or later after admission to hospital had a 1.59-times increased odds of 30-day mortality when compared with surgery within 12 hours of admis-sion.…”

mentioning

confidence: 99%

Surgery for a fracture of the hip within 24 hours of admission is independently associated with reduced short-term post-operative complications

Boddapati

Gausden

et al. 2017

The Bone & Joint Journal

View full text Add to dashboard Cite

Aims We aimed to characterise the effect of expeditious hip fracture surgery in elderly patients within 24 hours of admission on short-term post-operative outcomes. Patients and Methods Patients age 65 or older that underwent surgery for closed femoral neck and intertrochanteric hip fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program between 2011 and 2014. Multivariable propensity-adjusted logistic regressions were performed to determine associations between early surgery within 24 hours and post-operative complications, controlling for selection bias in patients undergoing early surgery based on observable characteristics. Results A total of 26 051 patients were included in the study; 5921 (22.7%) had surgery within 24 hours of admission, while 20 130 (77.3%) patients had surgery after 24 hours. Propensity-adjusted multivariable logistic regressions demonstrated that surgery within 24 hours was independently associated with lower odds of respiratory complications including pneumonia, failure to extubate, or reintubation (odds ratio (OR) 0.78, 95% confidence interval (CI) 0.67 to 0.90), and extended length of stay (LOS) defined as ≥ 6 days (OR 0.84, 95% CI 0.78 to 0.90). Conclusion In elderly patients with hip fractures, early surgery within 24 hours of admission is independently associated with less pulmonary complications including pneumonia, failure to extubate, and reintubation, as well as shorter LOS. Cite this article: Bone Joint J 2017;99-B:1216–22.

show abstract

Proximal Femoral Fractures in the Elderly: Does Operative Delay for Medical Reasons Affect Short-term Outcome?

Cited by 14 publications

References 0 publications

Does timing of surgery matter in fragility hip fractures?

Does timing of surgery matter in fragility hip fractures?

Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis

Surgery for a fracture of the hip within 24 hours of admission is independently associated with reduced short-term post-operative complications

Contact Info

Product

Resources

About