Timing of surgery for hip fractures: A systematic review of 52 published studies involving 291,413 patients

Khan, Sameer K.; Kalra, Sanjay; Khanna, Anil; Thiruvengada, Madhan M.; Parker, Martyn J.

doi:10.1016/j.injury.2009.01.010

Cited by 341 publications

(236 citation statements)

References 53 publications

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“…However, the effect of this delay on patient mortality is controversial and variations across studies may depend on failure to adjust for confounding variables or on the adjustment for different variables [16]. Our study contributes additional evidence to this ongoing debate.…”

Section: Discussionmentioning

confidence: 82%

“…Lastly, a systematic review of 52 published studies failed to identify a clear relationship between timing of surgery and mortality rate, but suggested that a procedure performed within 48 hours of the fracture event can shorten hospital stay and decrease the complication rate [16]. A recent study showed that time from hospital admission to surgery can be reliably used as a surrogate of the actual time from fracture to surgery when studying hip fracture mortality [17].…”

Section: Introductionmentioning

confidence: 99%

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Hip fracture: effectiveness of early surgery to prevent 30-day mortality

Carretta

Bochicchio

Rucci

et al. 2010

International Orthopaedics (SICOT)

102

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To estimate the effect of delay to surgery for hip fracture on 30-day mortality using a risk adjustment strategy to control for the effect of demographic and clinical confounders. This observational study was carried out on all patients admitted with a hip fracture and discharged between January 2004 and December 2007 from a teaching hospital. Gender, age, time to surgery, mortality and medical comorbidities were derived from hospital discharge records (SDO), while International Normalised Ratio (INR) and American Society of Anaesthesiologists (ASA) score were retrieved from clinical records. Backward stepwise logistic regression was used to identify potential confounders in the relationship between time to surgery and mortality. A final multivariate logistic regression analysis was carried out controlling for the effect of confounders. In the 1320 patients who underwent surgery (mean age = 83 years, % female = 76.8%), time to surgery was two days or less in 746 (56.5%) patients and 30-day mortality was 3.5%. The interventions included partial or total hip replacement (N=820, 62.1%) and reduction and internal fixation (N=500, 37.9%). Multivariate logistic regression analysis showed that patients with a time to surgery greater than two days had a 2-fold increase in 30-day mortality after adjusting for age, gender, and comorbidity (OR=1.992, 95% CI 1. 065-3.725). In a second model also including ASA score the odd ratio decreased to 1.839 (95% CI 0.971-3.486). Patients with a hip fracture should have surgery within two days from admission in order to reduce 30-day mortality.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Hip fracture: effectiveness of early surgery to prevent 30-day mortality

Carretta

Bochicchio

Rucci

et al. 2010

International Orthopaedics (SICOT)

102

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“…8 A systematic review of 52 published studies involving 291 143 patients was recently performed by Khan et al They observed that when studies adjusted for confounding factors, they were less likely to report improved survival outcomes from early surgery. 17 When Vidán et al controlled for additional variables such as older age, dementia, and chronic comorbidities, they found that delaying surgery up to 5 days had no influence on mortality. 18 Based on their results, the authors concluded that patients with a poorer baseline health status underwent more delayed surgery and that this association alone accounted for the poorer outcomes in patients who had delays.…”

Section: Surgical Timing and Mortalitymentioning

confidence: 99%

Timing of Hip Fracture Surgery in the Elderly

Lee

Elfar

2014

Geriatr Orthop Surg Rehabil

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The effect of preoperative wait time for surgery is a long-standing subject of debate. Although there is disagreement among clinicians on whether early surgery confers a survival benefit per se, most reports agree that early surgery improves other outcomes such as length of stay, the incidence of pressure sores, and return to independent living. Therefore, it would seem prudent to surgically treat elderly patients with hip fractures within the first 48 hours of admission. However, the current body of evidence is observational in nature and carries the potential for bias inherent in such analyses. Evidence in the form of a large randomized controlled trial may ultimately be required to fully evaluate the impact of surgical timing on patients with fractures of the hip.

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“…Traditionally, surgery was postponed until patients had recovered from any acute illness and were deemed 'fit' for anaesthesia and surgery, resulting in pre-operative delay. There is now very strong evidence that delay from hospital admission to surgery increases mortality, lengthens hospital stay and delays functional recovery [67,68]. Delays normally relate to either organisational (51%) or medical (44%) problems, both of which are amenable to managed reduction [69].…”

Section: Pre-operative Optimisationmentioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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Timing of surgery for hip fractures: A systematic review of 52 published studies involving 291,413 patients

Cited by 341 publications

References 53 publications

Hip fracture: effectiveness of early surgery to prevent 30-day mortality

Hip fracture: effectiveness of early surgery to prevent 30-day mortality

Timing of Hip Fracture Surgery in the Elderly

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

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