Research Update: Hip Fractures
Time to surgery and mortality following hip fracture.
Persell, S. D. (2002). Journal of Clinical Outcomes Management, 9(9), 489–490.
The objective of the study was to determine the effect of time to surgery on mortality and morbidity in elderly individuals with a hip fracture and active medical problems. This retrospective cohort study involved 8,383 consecutive patients, aged 60 years or older, who underwent surgical repair of a hip fracture between 1983 and 1993 in 20 hospitals in 4 metropolitan U.S. areas. Medical chart reviews and the National Death Index were used as data sources. The primary endpoint was all-cause mortality. Secondary endpoints included 30-day mortality, decubitus ulcer formation, serious bacterial infection, myocardial infarction, and venous thromboembolism.
No patient with active medical problems had surgery within 24 hours of admission. After treatment for underlying medical problems, there was no difference in long-term or 30-day mortality for patients having surgery 48 to 72 hours after admission when compared with 24 to 48 hours. An association between delay of surgery for more than 72 hours and mortality could not be adequately assessed, because few patients had surgery more than 72 hours after admission.
The investigators concluded that there was no increase in postoperative mortality with delay of the surgical repair of a hip fracture for up to 72 hours. The study results have application to clinical practice. If there are no medical reasons for a delay, the surgical repair should be performed as soon as possible after admission. However, if there are medical problems, the surgical procedure can be postponed for up to 72 hours to bring the medical problem under control without increasing the mortality risk to the patient.