The impact of time to surgery after hip fracture on mortality at 30- and 90-days: Does a single benchmark apply to all?

Beaupré, Lauren A; Khong, Hoa; Smith, Christopher; Kang, Sung Hyun; Evens, L; Jaiswal, Pradeep; Powell, James

doi:10.1016/j.injury.2019.03.031

Cited by 54 publications

(58 citation statements)

References 22 publications

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“…By contrast, a delay of up to 48 hours post-admission does not affect mortality according to a cohort study of over 70,000 patients from the Norwegian Hip Fracture Register (Leer-Salvesen et al 2019). Elderly patients with hip fractures have higher mortality risk following surgical delay, a risk that is enhanced in men and patients with multiple comorbidities (Beaupre et al 2019). Greve et al (2020) reported higher mortality in patients with an ASA score of 3-4, but surprisingly also in women, when surgical waiting time was > 24 hours from admission.…”

Section: Discussionmentioning

confidence: 99%

How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

et al. 2020

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Background and purpose — Unlike hip fractures, diaphyseal and distal femoral fractures in elderly patients have not been widely studied. We investigated the demographics, comorbidities and mortality of patients with femoral fractures at any anatomical level with a focus on early mortality. Patients and methods — We analyzed 11,799 patients ≥ 65 years with a femoral fracture registered in the Swedish Fracture Register from 2011 to 2014. The cohort was matched with the National Patient Register to obtain data on comorbidities classified according to the Charlson Comorbidity Index (CCI). Generalized linear models were fitted to estimate the adjusted relative risk of mortality. Results — Mean age of the cohort was 83 years and 69% were women. Patients with distal femoral fractures had the lowest degree of comorbidity, with 9% having a CCI of ≥ 3 compared with 14% among those with proximal and 16% among those with diaphyseal fractures. Unadjusted 90-day mortalities were 13% (95% CI 9.4–16) after fractures in the distal, 13% (CI 10–16) in the diaphyseal, and 15% (CI 14–15) in the proximal segment. The adjusted relative risk for 90-day mortality was 1.1 (CI 0.86–1.4) for patients with distal and 0.97 (CI 0.76–1.2) for patients with diaphyseal femoral fractures when compared with patients with hip fractures. Interpretation — Elderly patients with femoral fractures distal to the hip may have similar adjusted early mortality risks to those with hip fractures. There is a need for larger, preferably prospective, studies investigating the effect of rapid pathways and geriatric co-management for patients with diaphyseal and distal femoral fractures.

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Section: Discussionmentioning

confidence: 99%

How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

et al. 2020

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“…Time to surgery following hip fracture played an important role in the prognosis of patients. 22 Some recent studies have suggested that delay in surgery after hip fracture increased the risk of in-hospital complications. 23,24 While some guidelines recommend that hip fracture surgery should be conducted within 24-48 hours, the optimal cut-off time for time to surgery is still controversial.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

Zhao

Zhang

et al. 2020

International Wound Journal

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Surgical site infection (SSI) is a challenging complication after intertrochanteric fracture surgery but without a large‐sample size study to investigate the incidence and risk factors of it. The present study was to investigate the incidence and risk factors of SSI after intertrochanteric fracture surgery. A total of 1941 patients underwent intertrochanteric fracture surgery between October 2014 and December 2018 were included. Demographic data, surgical variables, and preoperative laboratory indexes were obtained from a prospective database and reviewed by hospital records. The optimum cut‐off value for quantitative data was detected by receiver operating characteristic analysis. The univariate analysis and multivariable analysis were conducted to analyse the risk factors. In total, 25 patients (1.3%) developed SSI, including 22(1.1%) superficial infection and 3(0.2%) deep infection. After adjustment of multiple variables, gender (odds ratio[OR] 2.64, P = .024), time to surgery>4 days (OR 2.41, P = .046), implant (intramedullary or extramedullary devices) (OR 2.96, P = .036), ALB<35 g/L (OR 2.88, P = .031) remained significant factors. In conclusion, the incidence of SSI after intertrochanteric fractures surgery was 1.3%, with 1.1% for superficial and 0.2% for deep infection. Gender, time to surgery>4 days, the implant (intramedullary or extramedullary devices), and ALB<35 g/L were independent risk factors for the rate of SSI.

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“…3 Several factors influence mortality at one-year, including socioeconomic status and the wait time for surgery. 4 Ensuring access to the resolution of this pathology reduces health costs, increases survival, and improves the life quality of the patients. 5 Despite the importance of this pathology and several studies reporting mortality at 1 year since hip fracture, no long-term survival analysis has been published; therefore, the impact on long-term survival compared to the general population and the long-term effect of wait time for surgery are unknown.…”

Section: Introductionmentioning

confidence: 99%

Survival analysis after hip fracture: higher mortality than the general population and delayed surgery increases the risk at any time

et al. 2020

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Purpose: To estimate survival curves in patients with hip fracture according to gender, age, type of fracture, and waiting time for surgery and to compare them with the life expectancy of the general population. The study hypothesis is that survival after hip fractures is significantly lower than in the general population, especially in cases that underwent delayed surgery, regardless of age and gender. Methods: A survival analysis study was designed and approved by our institutional ethics review board. All patients who were coded with a diagnosis of hip fracture from 2002 to 2018 were included in the study. A total of 1176 patients were included, and the median age was 81 years (18–105 years). Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who underwent surgery on time and those with surgical delays. An exponential multivariate regression model was estimated, and a hazard ratio (HR) was reported for age, gender, and wait time for surgery. A significance of 5% was used, and a confidence interval level of 95% was reported. Results: The Kaplan-Meier curves for delayed surgery (log-rank, p = 0.00) and the age group (log-rank, p = 0.00) were significantly different. Exponential regression estimated an HR 1.05 (1.05–1.07) for age, HR 1.80 (1.51–2.13) for men, and HR 1.93 (1.61–2.31) for each day of wait for surgery. Conclusions: The 2 significant findings of this study are that hip fracture patients over 40 years old have a higher risk of dying at any time compared to the general population and that the waiting time for surgery (a modifiable factor) decreases survival rates at any time.

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The impact of time to surgery after hip fracture on mortality at 30- and 90-days: Does a single benchmark apply to all?

Cited by 54 publications

References 22 publications

How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

Survival analysis after hip fracture: higher mortality than the general population and delayed surgery increases the risk at any time

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