Waiting time for hip fracture surgery: hospital variation, causes, and effects on postoperative mortality

Kjærvik, Cato; Gjertsen, Jan‐Erik; Engeseter, Lars B.; Stensland, Eva; Dybvik, Eva; Soereide, Odd

doi:10.1302/2633-1462.29.bjo-2021-0079.r1

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…Possible explanations might be the selection of frail and high-risk patients to be treated by experienced surgeons, and the fact that patients treated with arthroplasty are preferentially operated on by more experienced surgeons and wait longer than other patients. 12 Orthogeriatric assessment is recommended to improve functional outcomes, 14 and has been shown to reduce mortality in FnFs receiving arthroplasty by roberts et al 22 in this study, orthogeriatric services were associated with lower mortality, all fracture types included. in a systematic review, abrahamsen et al 1 found that increased mortality might be elevated for years after injury, particularly for males.…”

Section: Discussionmentioning

confidence: 60%

“…11 nPr also provided times of admission and procedures, which facilitated calculation of in-hospital waiting time for surgery, and identified patients treated with expedited surgery (within the day following admission). 12,13 Combining information on fracture type and treatment from the NHFR and waiting time from the NPR, we defined recommended surgical treatment within 48 hours of admission as best practice (according to national guidelines). 14 We collected demographic information (marital status and household type) and socioeconomic data (household income, highest completed education level, and residential status) from Statistics Norway (SN).…”

Section: Methodsmentioning

confidence: 99%

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Modifiable and non-modifiable risk factors in hip fracture mortality in Norway, 2014 to 2018

Kjærvik

Gjertsen

Stensland

et al. 2022

The Bone & Joint Journal

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Aims This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality. Methods Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population. Results Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of orthogeriatric services) were associated with increased mortality. Non-modifiable risk factors were more strongly associated with mortality than modifiable risk factors. The SMR analysis suggested that cumulative excess mortality among hip fracture patients was 16% in the first year and 41% at six years. SMR was 2.48 for the six-year observation period, most pronounced in the first year, and fell from 10.92 in the first month to 3.53 after 12 months and 2.48 after six years. Substantial differences in median survival time were found, particularly for patient-related factors. Conclusion Socioeconomic, patient-, and healthcare-related factors all contributed to excess mortality, and non-modifiable factors had stronger association than modifiable ones. Hip fractures contributed to substantial excess mortality. Apparently small survival differences translate into substantial disparity in median survival time in this elderly population. Cite this article: Bone Joint J 2022;104-B(7):884–893.

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Section: Discussionmentioning

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Modifiable and non-modifiable risk factors in hip fracture mortality in Norway, 2014 to 2018

Kjærvik

Gjertsen

Stensland

et al. 2022

The Bone & Joint Journal

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“…Many factors have been identified to affect the waiting time for surgeries among patients with hip fractures. This was supported by a retrospective analysis done in Norway [15]; although the mean preoperative waiting time was 22.6 hours, delayed surgeries were associated with increased 30-day and one-year mortality rates [15].…”

Section: Discussionmentioning

confidence: 88%

One-Year Mortality Rates Following Fragility Femoral Fractures in Patients Presenting to King Saud Medical City in Riyadh, Saudi Arabia: A Retrospective Study

ALJohani¹,

Alshugair²,

Alfadhel³

et al. 2022

Cureus

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Objective: The objective is to investigate one-year mortality rates following femur osteoporotic fractures, and to investigate factors that are associated with higher mortality rates. Design: A retrospective study was conducted from 2010 to 2021 (11 years) of all patients who presented to King Saud Medical City, Saudi Arabia, and had a fragility fracture of the proximal or distal femur. Patients: One hundred eight patients who sustained a proximal or distal femoral fracture, as a result of low-energy trauma, were included. Results: The majority of our cohort (77.8%) had proximal femoral fractures, whereas only 22.2% had a distal femoral fracture. 55.6% were less than 75 years old, and 44.4% were 75 years or older. All patients had fallen from standing height. Hypertension and diabetes were the most common comorbidities among our cohort at 49.1% and 47.2%, respectively, but neither showed a statistically significant increase in the risk of mortality. When assessing the overall mortality, 21.3% of our patients had passed away. Although this finding was not statistically significant, mortality rates were found to be higher in patients with proximal femoral fractures compared to distal femoral fractures (25% vs. 8.3%, respectively, p=0.095). Patients with a normal bone mass density (BMD) had higher mortality rates as opposed to those with abnormal BMD (p=0.001). Conclusions: Mortality rates are higher in proximal femoral fractures compared to distal femoral fractures. In addition, within our study cohort, patients with normal BMD had higher mortality rates. We recommend prospective studies that compare mortality rates between proximal and distal femoral fractures in patients with osteoporosis, as these studies would provide more accurate data. We also recommend having BMD measured in those patients to avoid further fractures in this patient population.

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“…[5][6][7][8][16][17][18]20,[22][23][24][25][26] A large previous cohort study concluded that prolonged time to surgery was associated with higher 30-day and one-year mortality rates. 35 However, that study does not exclude patients who need preoperative optimization. 35 Thus, to optimize the more frail patients preoperatively more time would have been needed.…”

Section: Discussionmentioning

confidence: 99%

“…35 However, that study does not exclude patients who need preoperative optimization. 35 Thus, to optimize the more frail patients preoperatively more time would have been needed. The results of that study do show this, as patients with longer time to surgery have higher CCI scores.…”

Section: Discussionmentioning

confidence: 99%

Influence of time to surgery on clinical outcomes in elderly hip fracture patients

Rijckevorsel

Jong

Verhofstad

et al. 2022

The Bone & Joint Journal

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Aims Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize clinical outcomes after hip fracture surgery. This study aims to determine the influence of postponement of surgery due to non-medical reasons on clinical outcomes in acute hip fracture surgery. Methods This observational cohort study enrolled consecutively admitted patients with a proximal femoral fracture, for which surgery was performed between 1 January 2018 and 11 January 2021 in two level II trauma teaching hospitals. Patients with medical indications to postpone surgery were excluded. A total of 1,803 patients were included, of whom 1,428 had surgery < 24 hours and 375 had surgery ≥ 24 hours after admission. Results Prolonged total length of stay was found when surgery was performed ≥ 24 hours (median 6 days (interquartile range (IQR) 4 to 9) vs 7 days (IQR 5 to 10); p = 0.001) after admission. No differences in postoperative length of hospital stay nor in 30-day mortality rates were found. In subgroup analysis for time frames of 12 hours each, pressure sores and urinary tract infections were diagnosed more frequently when time to surgery increased. Conclusion Longer time to surgery due to non-medical reasons was associated with a higher incidence of postoperative pressure sores and urinary tract infections when time to surgery was more than 48 hours after admission. No association was found between time to surgery and 30-day mortality rates or postoperative length of hospital stay. Cite this article: Bone Joint J 2022;104-B(12):1369–1378.

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Waiting time for hip fracture surgery: hospital variation, causes, and effects on postoperative mortality

Cited by 17 publications

References 18 publications

Modifiable and non-modifiable risk factors in hip fracture mortality in Norway, 2014 to 2018

Modifiable and non-modifiable risk factors in hip fracture mortality in Norway, 2014 to 2018

One-Year Mortality Rates Following Fragility Femoral Fractures in Patients Presenting to King Saud Medical City in Riyadh, Saudi Arabia: A Retrospective Study

Influence of time to surgery on clinical outcomes in elderly hip fracture patients

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