The effect of time to surgery in neck of femur fracture patients with ASA Grade of 3 and above

Abstract

Introduction: Hip fractures are an important cause of morbidity and mortality. Early surgery has been shown to reduce mortality rates and surgical complications. The American Society of Anesthesiologists (ASA) grade is a widely used tool to assess preoperative health of patients. This study aims to assess is whether delay in surgical time has a greater impact on the mortality rates for high risk patients. Method: Retrospective study using the National Hip Fracture Database (NHFD) of 4883 neck of femur fracture patients. Time of surgery, ASA grade, reason for delay and mortality at 120 days was analysed, using statistical analysis software. Results: There was a significant increase in mortality ( p < 0.001) with increasing ASA grade. Surgical delays of more than 36 hours increased mortality by 2.9%. The impact of delaying surgery became more pronounced as the ASA grade increased. ASA 3 and above had an optimum time to surgery of between 12 and 24 hours giving the statistically significant lowest mortality rate ( p = 0.004). Discussion: Surgical delay beyond the 36-hour target for surgery has a greater impact on mortality for patients with higher ASA grades. The effect is most profound in the high-risk ASA grade 5 patients with delayed patients showing a 37.5% increase in mortality in this group. This would imply that by prioritising this higher risk group and operating on it within a specific time frame there would be a subsequent fall in mortality associated with neck of femur fractures.

Risk Factors of 120-Day Mortality Among Hip Fractures With Concomitant COVID-19 Infection

“…Dar et al suggested that having delayed surgery did not significantly increase mortality [ 19 ]. The findings of this study are quite contradictory to a systematic review done by Khan et al, who suggested early surgery for hip fractures decreases both the mortality and length of hospital stay [ 20 ]. In our study, 70% of patients who had delayed surgery of more than 36 hours died within 120 days of surgery (p < 0.001).…”

A Case-Control Study of Hip Fracture Surgery Timing and Mortality at an Academic Hospital: Day Surgery May Be Safer than Night Surgery

“…After controlling for all these factors simultaneously, the multivariable logistic regression revealed the only factor independently associated with 90-day mortality was a night operation. This is an interesting finding considering that most studies identifying time from admission to OR as a significant factor for mortality did not control for operative start time (day versus night) in their analyses [6,12,[14][15][16][17].…”

“…Furthermore, traditional thinking regarding admission to OR time has also been reassessed in the setting of delaying procedures due to patients' anticoagulation medication [26]. It is also believed that comorbid status may mediate the relationship between time to surgery and mortality [16,27]. Furthermore, other esoteric factors such as those involving the resources of the patient's health care system and surgeon variability may also influence this relationship but are not fully captured by current research.…”

“…Time from hospital admission to operating room (OR) has consistently been demonstrated to have a significant impact on mortality rates and postoperative outcomes. Decreased mortality rates have been observed in patients receiving surgery within 12 [14,15], 24 [6,12], 36 [16], 48 [17][18][19], and 72 [20][21][22] hours of hospital admission. Contrarily, operative delay to medically optimize patients may be essential and may not contribute to increased mortality [23][24][25].…”