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

Abstract

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.

Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada

“…Although most patients (> 75%) were admitted to hospital within 6 hours of presentation at the emergency department (mean 7.58 h [SD 11.87]), only 14 174 (33.5%) received surgery within the recommended time frame (24 h) ( Figure 1). 1,47,48 The proportion of patients with hip fracture is also reported by their time of presentation, admission and surgery in Appendix 2, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.170830/-/ DC1. Whereas 5837 patients (13.8%) arrived overnight, only 441 patients (1.0%) received surgery during this time.…”

“…Two-thirds (66%) of the participants did not receive surgery within the safe time frame (24 h). 1,47,48 Variation within Ontario's public health care system warrants performance improvement at the hospital level.Variation in wait times was attributable to treatment at different hospitals, as opposed to treatment by different phys icians. As such, initiatives for quality improvement may target hospitallevel processes preferentially rather than individual physician practices.…”

“…An advantage of these Canadian data compared with data from the United States is the ability to capture exact wait times in hours (versus days) and the time elapsed in transfer between hospitals. 48,58 Other potential applications of these data include more accurately identifying afterhours surgery, 19 durations of surgery 59 and overlapping surgical procedures. …”

Trends in the surgical treatment of pathological proximal femur fractures in the United States

“…Readmission and discharge destination data were available beginning in 2011. Finally, an extended length of postoperative stay was defined as discharge more than 6 days after surgery, which was defined at the 75th percentile in this study and others …”

“…Consistent with previous methods, patients with PPFFs were identified by using International Classification of Diseases (ICD) codes for pathologic fracture (ICD‐9: 733.1X or ICD‐10: M84.4/5X) that were surgically treated with Common Procedural Terminology (CPT) codes for hip hemiarthroplasty (27125/27236), total hip arthroplasty (27130), fixation of proximal femur fracture with plate/screw construct (27244), or fixation of proximal femur fracture with intramedullary implant (27245) . Patients with femoral shaft and distal femur fractures were not included in this study to provide a relatively uniform population of PPFFs.…”