The association between surgical fixation of hip fractures within 24 hours and mortality

Welford, Paul; Jones, Conor S; Davies, Gareth T.; Kunutsor, Setor K; Costa, Matthew L.; Sayers, Adrian; Whitehouse, Michael R

doi:10.1302/0301-620x.103b7.bjj-2020-2582.r1

Cited by 34 publications

(30 citation statements)

References 64 publications

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“…The in-hospital mortality in the present study agrees with the risk about 2% reported currently [20], and female gender was not a significant predictor, while female was significant in the cohort by Forni et al [20]. A recent meta-analysis [21] indicated reduced mortality for patients operated within 24 h compared with those operated within 36 h. Contrary, other recent study [22]) reported that early surgery within 48 and 72 h was significantly associated with a lower in-hospital mortality in patients older than 85 years. In a prior study [23], we found that patients with severe active comorbidities could benefit from surgery delayed more than 2 days.…”

Section: Discussionsupporting

confidence: 89%

Change in 1-year mortality after hip fracture surgery over the last decade in a European population

Miralles‐Muñoz

Perez-Aznar

González-Parreño

et al. 2022

Arch Orthop Trauma Surg

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Objective There are scarce data on the mortality after hip fracture surgery for patients treated in the most recent years. The objective of this study was to analyze whether the overall initiatives introduced over the last decade for elderly patients with hip fractures had a positive impact on the 1-year mortality. Methods Patients treated during 2010–2012 were compared with patients treated during 2018–2020 for all-cause 1-year mortality. Variables influencing mortality were collected based on the literature, including demographic, comorbidity, cognitive status, and preinjury physical function. Crude mortalities were compared between periods, as well as with the expected mortality in the general population adjusted for age, gender, and year of surgery using the standardized mortality ratio (SMR). A multivariate model was used to identify mortality risk factors. Results 591 patients older than 65 years were treated during 2010–2012 and 642 patients during 2018–2020. The mean age increased significantly between periods (78.9 vs. 82.6 years, respectively, p = 0.001) in both genders, together with an increase in comorbidity (p = 0.014). The in-hospital mortality risk had no significant difference between periods (2.5 vs. 2.0%, p = 0.339), but the 30-day mortality risk (8.3 vs. 5.5%, p = 0.031) and 1-year mortality risk (16.1 vs. 11.9%, p = 0.023) declined significantly. However, 1-year mortality in 2020 had an excess of 1.33 in SMR. Age older than 80 years, male gender, and Charlson comorbidity index > 2 were significant predictors of 1-year mortality. Conclusion The important evolution achieved in the last decade for the management of patients with hip fracture surgery has led to a significant decline in 1-year mortality, but the 1-year mortality remains significantly higher compared to the general population of similar age and gender.

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Section: Discussionsupporting

confidence: 89%

Change in 1-year mortality after hip fracture surgery over the last decade in a European population

Miralles‐Muñoz

Perez-Aznar

González-Parreño

et al. 2022

Arch Orthop Trauma Surg

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“…Most studies set the goal of early surgery within 48 h from admission, supported by highly significant associations with lower mortality rate at different end-points [2, 4, 8, 19, 23, 24, 31-34, 38, 39]. However, some studies identify the threshold at 24 h to be significantly related to better outcome, both at short and mid-term [4,[19][20][21][22][23][24][25][26][27][28][29][30]40]. Conversely, some studies set 72 h as the limit for early surgery, with more conflicting results [8,24,33].…”

Section: Discussionmentioning

confidence: 99%

Should the early surgery threshold be moved to 72 h in over-85 patients with hip fracture? A single-center retrospective evaluation on 941 patients

Luca

Murena

Zanetti

et al. 2022

Arch Orthop Trauma Surg

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Aim Aim of the study was to assess whether early surgery and other clinical and orthogeriatric parameters could affect mortality rate in hip fracture patients aged > 85. Materials and methods Data regarding a 42-month period were retrospectively obtained from the institutional medical records and registry data. Gender, age, fracture pattern, surgical technique, type of anesthesia, timing of surgical intervention (within 24, 48 or 72 h from admission), days of hospitalization, mortality rate divided in intra-hospital, at 30 days and at 1 year were collected for the whole population. Some additional data were collected for an orthogeriatric subgroup. Results 941 patients were considered, with a mean age of 89 years. Surgery was performed within 24, 48 and 72 h in 24.4%, 54.5% and 66.1% of cases, respectively. Intra-hospital mortality rate resulted to be 3.4%, while mortality at 30 days and 1 year resulted to be 4.5% and 31%, respectively. Early surgery within 48 and 72 h were significantly associated with a lower intra-hospital and 30-day mortality rate. In the orthogeriatric subgroup (394 patients), a significant association with a higher mortality rate was found for general anesthesia, number of comorbidities, ADL (Activities of Daily Living) < 3, transfer to other departments. Conclusions In over-85 hip fracture patients, the threshold for early surgery might be moved to 72 h to allow patients pre-operative stabilization and medical optimization as intra-hospital and 30-day mortality rates remain significantly lower. Advanced age, male sex, number of comorbidities, pre-operative dependency in ADL, general anesthesia, length of hospitalization and transfer to other departments were significantly related to mortality rate.

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“…The influence of surgical delay on postoperative prognosis was deleterious. Mortality significantly increased for patients receiving hip repair surgery >24 hours after admission compared with those operated on within 24 hours [11]. A surgical delay of >21 days had a significantly poorer hip function and QoL than an operation within 7 days of the fracture [12].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Mortality, Activity of Daily Living, and Quality of Life in Taiwanese Older Patients within 1 Year Following Hip Fracture Surgery

Chiang

Huang

Kuo

et al. 2022

JPM

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Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. This is a prospective cohort study enrolling older adults (≥60 years) who had undergone hip fracture surgery in a single medical center. The comprehensive clinical history of each patient was examined. QoL, ADL, and mortality events were recorded consecutively at 3, 6, and 12 months after operation. The multiple logistic regression model and the generalized estimating equation (GEE) were adopted to identify contributing factors for mortality and postoperative ADL and QoL prognosis, respectively. Results. Among 377 participants with hip fracture, 48 died within 1 year of the index operation. ADL and QoL considerably decreased at 3 months following hip surgery. Old age, high Charlson Comorbidity Index, and American Society of Anesthesiologists grading were crucial predictors for mortality at the 1-year follow-up. The generalized estimating equation analysis indicated that the length of postoperative follow-up time, serum albumin level, patient cognitive status, and handgrip strength were considerably associated with QoL and ADL recovery prognosis in the Taiwanese older adults following hip fracture. Conclusions. Hip fractures have long-lasting effects on the older adults. Our data imply several prognosis predicting parameters that may assist clinicians in accounting for an individual’s personalized risks in order to improve functional outcomes and reduce mortality.

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The association between surgical fixation of hip fractures within 24 hours and mortality

Cited by 34 publications

References 64 publications

Change in 1-year mortality after hip fracture surgery over the last decade in a European population

Change in 1-year mortality after hip fracture surgery over the last decade in a European population

Should the early surgery threshold be moved to 72 h in over-85 patients with hip fracture? A single-center retrospective evaluation on 941 patients

Prognostic Factors for Mortality, Activity of Daily Living, and Quality of Life in Taiwanese Older Patients within 1 Year Following Hip Fracture Surgery

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