The effects of time-to-surgery on mortality and morbidity in patients following hip fracture

Grimes, Julia P; Gregory, Patrice M.; Noveck, Helaine; Butler, Mark S.; Carson, Jeffrey L.

doi:10.1016/s0002-9343(02)01119-1

Cited by 298 publications

(254 citation statements)

References 25 publications

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“…As mentioned previously, these findings suggest delay of surgery may be a confounding factor related to the dependent (mortality) and the independent variables (comorbidity), rather than a causative factor of mortality. This idea is further supported by studies showing, after adjusting for patient age, gender, and comorbidities, surgical delay greater than 1 day does not lead to an increase of mortality [21,24,30,47]. However, other studies have shown, even after adjusting for comorbidities, surgical delay greater than 48 hours led to an increase in 30-day and 1-year mortality rates [7,34,37,41,50].…”

Section: Discussionmentioning

confidence: 90%

Mortality After Distal Femur Fractures in Elderly Patients

Streubel

Ricci

Wong

et al. 2011

Clinical Orthopaedics &Amp; Related Research

245

163

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Background Hip fractures in the elderly are associated with high 1-year mortality rates, but whether patients with other lower extremity fractures are exposed to a similar mortality risk is not clear. Questions/purposes We evaluated the mortality of elderly patients after distal femur fractures; determined predictors for mortality; analyzed the effect of surgical delay; and compared survivorship of elderly patients with distal femur fractures with subjects in a matched hip fracture group. Patients and Methods We included 92 consecutive patients older than 60 years with low-energy supracondylar femur fractures treated between 1999 and 2009. Patient, fracture, and treatment characteristics were extracted from operative records, charts, and radiographs. Data regarding mortality were obtained from the Social Security Death Index. Results Age-adjusted Charlson Comorbidity Index and a previous TKA were independent predictors for decreased survival. Congestive heart failure, dementia, renal disease,

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Section: Discussionmentioning

confidence: 90%

Mortality After Distal Femur Fractures in Elderly Patients

Streubel

Ricci

Wong

et al. 2011

Clinical Orthopaedics &Amp; Related Research

245

163

View full text Add to dashboard Cite

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“…Twenty-one of these were excluded, 13 with insufficient data and eight that did not meet our criteria. Thus, five prospective 13-17 and 11 retrospective studies 5,6,[18][19][20][21][22][23][24][25][26] were included in our analysis. One report 17 was excluded from the analysis of 30-day mortality because of possible duplication with another study; 13 but it was included in the analysis of one-year mortality because the other study 13 was not included in this analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The median quality index was 14 (range: 11-17). Thirteen trials 5,6,13,15,16,[19][20][21][22][23][24][25][26] (236,179 patients) evaluated 30-day mortality in association with early vs delayed surgery. Mortality occurred in 5,438 of 54,988 patients for whom surgery was delayed and in 12,580 of 181,191 patients for whom surgery was early.…”

Section: Resultsmentioning

confidence: 99%

“…Six retrospective studies 5,6,19,[22][23][24] computed an adjusted odds ratio for 30-day mortality; and two retrospective studies 20,23 computed an adjusted odds ratio for one-year mortality by means of a multivariate logistic regression model or multivariate Cox proportional hazards model. Therefore, we combined the adjusted odds ratios for 30-day and one-year mortality; and we compared these values with the unadjusted (crude) odds ratios.…”

Section: Subgroup and Sensitivity Analysismentioning

confidence: 99%

“…Five studies 13,14,16,17,19 examined the reasons for operative delay. Typical reasons included unavailability of an operating room; unavailability of the surgeon, anesthesiologist or nursing staff; and investigation into the patient's preoperative medical condition (Table I).…”

Section: Reasons For the Delaymentioning

confidence: 99%

See 2 more Smart Citations

Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

Shiga

Wajima

Ohe

2008

Can J Anesth/J Can Anesth

549

338

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Purpose: Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians' guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Methods: Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird randomeffects model. Results:Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI = 1.29-1.54, P < 0.001), and that for one-year mortality was 1.32 (95% CI = 1.21-1.43, P < 0.001). Conclusions: In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young.

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Trauma in the Elderly Patient

Victorino

Chong²,

Pal³

2003

Arch Surg

107

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dvanced age is a well-known risk factor for poor outcomes in trauma patients. Older patients can benefit from the intensive monitoring and aggressive management associated with trauma team involvement. Several common topics were chosen for discussion in which the treatment options may differ slightly because of the advanced age of the patient. We discuss the following selected topics: resuscitation of the elderly trauma patient, solid organ injuries, hip fractures, rib fractures, and head injuries.

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The effects of time-to-surgery on mortality and morbidity in patients following hip fracture

Cited by 298 publications

References 25 publications

Mortality After Distal Femur Fractures in Elderly Patients

Mortality After Distal Femur Fractures in Elderly Patients

Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

Trauma in the Elderly Patient

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