The timing of surgery for intertrochanteric femoral fractures

Davis, T. R. C.; Sher, J. L.; Porter, Bonita; Checketts, R. G.

doi:10.1016/0020-1383(88)90036-8

Cited by 59 publications

(36 citation statements)

References 4 publications

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“…Nevertheless, early surgery may be beneficial in patients with good general health and a high pre-fracture level of activity [14,20]. Early surgery may offer benefits in terms of shortened length of hospital stay [19,21,22], which, in turn, may prevent postoperative complications [19,[23][24][25]. Delay in surgery may contribute to the development of pressure ulcers.…”

Section: Resultsmentioning

confidence: 99%

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Pressure Ulcers and Prolonged Hospital Stay in Hip Fracture Patients Affected by Time-to-Surgery

Rademakers

Vainas

Zutphen

et al. 2007

Eur J Trauma Emerg Surg

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Background: Hip fractures are associated with high morbidity. Pressure ulcer formation after hip surgery is often related to delayed patient mobilization. The objectives of this study were to determine whether time-to-surgery affects development of pressure ulcers postoperatively and, thus, length of hospital stay. Patients and Methods:We performed a retrospective analysis of consecutive hip fracture patients, aged 60 years and above, who underwent surgery between 1995 and 2001. The primary outcome was in-hospital development of pressure ulcers. The secondary outcome measure was the overall length of hospital stay. Analyses were adjusted for relevant confounders. Results: Of the 722 patients enrolled, 488 patients (68%) received surgery at 12 h after admission. Approximately 30% (n = 214) developed pressure ulcers during admission, whilst 19% of patients operated within 12 h of admission developed pressure ulcers. Time-to-surgery was an independent predictor of both development of pressure ulcers (OR = 1.7, 95% confidence interval [CI] = 1.2-2.6; p = 0.008) and length of hospital stay (11.3 vs 13.3 days in the early and the late surgery group, respectively, p = 0.050). Furthermore, development of pressure ulcers was associated with prolonged postoperative hospital stay (19.5 vs 11.1 days for patients with and without pressure ulcers, respectively, p = 0.001) Interpretation: In hip fracture patients, time-to-surgery was an independent predictor of both postoperative pressure ulcer development and prolonged hospital stay. These data suggest that the implementation of an early surgery protocol following admission for hip fractures may reduce both the postoperative complications and overall hospital stay.

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Section: Resultsmentioning

confidence: 99%

“…Indeed recently, several authors demonstrated that surgical delay might be an independent predictor of pressure ulcer development [7,9,26,27]. However, others refuted this [14,16,23,28]. This could be related to the variation in the definition of early and late surgeries used by different authors.…”

Section: Resultsmentioning

confidence: 99%

Pressure Ulcers and Prolonged Hospital Stay in Hip Fracture Patients Affected by Time-to-Surgery

Rademakers

Vainas

Zutphen

et al. 2007

Eur J Trauma Emerg Surg

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“…Sixteen of these citations proved eligible for inclusion 8,12,15,[22][23][24][25][26][27][28][29][30][31][32][33][34] (Figure 1). Two studies were possible duplicates, but we included both in our analysis because one assessed long-term mortality 24 and the other assessed shortterm mortality.…”

Section: Studies Includedmentioning

confidence: 99%

“…The sample sizes of the included studies ranged from 65 to 3628 patients (Table 1 26 The preoperative interval was recorded from the time of injury to surgery in five studies 12,15,25,28,29 and from the time of admission to surgery in the remaining 11 studies. Eight studies reported the reasons for surgical delay, the most common being the unavailability of an operating room and/or surgical personnel, 12,24,25,27,31,32,34 and investigation and stabilization of the patient's preoperative medical condition.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…We judged four studies 8,[32][33][34] to be of high methodologic quality, five studies 15,22,24,27,31 to be of moderate quality and the remaining seven studies 12,23,25,26,[28][29][30] to be of low quality (Table 1). Agreement between reviewers in the assessment of study quality was excellent (intraclass correlation coefficient 0.92, 95% CI 0.75-0.97).…”

Section: Study Qualitymentioning

confidence: 99%

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Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis

Simunovic¹,

Devereaux²,

Sprague³

et al. 2010

Canadian Medical Association Journal

748

502

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Background: Guidelines exist for the surgical treatment of hip fracture, but the effect of early surgery on mortality and other outcomes that are important for patients remains unclear. We conducted a systematic review and meta-analysis to determine the effect of early surgery on the risk of death and common postoperative complications among elderly patients with hip fracture. Methods:We searched electronic databases (including MEDLINE and EMBASE), the archives of meetings of orthopedic associations and the bibliographies of relevant articles and questioned experts to identify prospective studies, published in any language, that evaluated the effects of early surgery in patients undergoing procedures for hip fracture. Two reviewers independently assessed methodologic quality and extracted relevant data. We pooled data by means of the DerSimonian and Laird random-effects model, which is based on the inverse variance method. Results:We identified 1939 citations, of which 16 observational studies met our inclusion criteria. These studies had a total of 13 478 patients for whom mortality data were complete (1764 total deaths). Based on the five studies that reported adjusted risk of death (4208 patients, 721 deaths), irrespective of the cut-off for delay (24, 48 or 72 hours), earlier surgery (i.e., within the cut-off time) was associated with a significant reduction in mortality (relative risk [RR] 0.81, 95% confidence interval [CI] 0.68-0.96, p = 0.01). Unadjusted data indicated that earlier surgery also reduced in-hospital pneumonia (RR 0.59, 95% CI 0.37-0.93, p = 0.02) and pressure sores (RR 0.48, 95% CI 0.34-0.69, p < 0.001).Interpretation: Earlier surgery was associated with a lower risk of death and lower rates of postoperative pneumonia and pressure sores among elderly patients with hip fracture. These results suggest that reducing delays may reduce mortality and complications. AbstractPreviously published at www.cmaj.ca Research Identification of studiesWe used multiple strategies to identify potentially eligible studies. With the help of a professional librarian, we searched the electronic databases MEDLINE and EMBASE for relevant articles in any language that were published up to and including Feb. 8, 2008. The complete search strategies are shown in Appendix 1 (available at www .cmaj .ca /cgi /content /full /cmaj .092220 /DC1). One reviewer (N.S.) also handsearched the archives of annual meetings of the Orthopaedic Trauma Association (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), the International Society of Orthopaedic Surgery and Traumatology (2003-2007), the Canadian Orthopaedic Association (2006)(2007), the European Federation of National Associations of Orthopaedics and Traumatology (2005-2007), the Mid-America Orthopaedic Association (2005, the Piedmont Orthopedic Society (2005Society ( -2007, the Association of Bone and Joint Surgeons (2005-2007) and the American Academy of Orthopaedic Surgeons (2006Surgeons ( -2007 for any relevant unpublished literature. Additiona...

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