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Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture

  • Orthopaedic Surgery
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Abstract

Introduction

The purpose of this study was to investigate the reasons for delayed surgery in patients with proximal hip fracture and to compare differences in mortality between delayed surgery cases and non-delayed surgery cases. In addition, we evaluated causal factors for delayed surgery that affected differences in mortality.

Methods

From 2003 to 2013, 1290 patients (1290 hips) with unilateral femoral neck or intertrochanteric fractures who underwent surgery were categorized into Group Ia (402 patients, early surgery group) and Group Ib (888 patients, delayed surgery group). The delayed surgery group was categorized as Group IIa (270 patients, pre-hospital delay group) and Group IIb (618 patients, post-hospital delay group). Among 618 patients with post-hospital delay, 165 patients in Group IIIa were defined as delayed surgery cases due to patient factors, and 453 patients in Group IIIB were defined as delayed surgery cases due to hospital factors. Early and late mortality was compared between each group.

Results

Of 1290 patients, 888 patients underwent delayed surgery (mean 7.5 days, range 3–167 days) after hip fracture. The cumulative mortality rate at 30, 60 days, 3, and 12 months was 0.7, 2.0, 3.0, and 9.5% in Group Ia, respectively, and 2.4, 4.5, 5.2, and 14.5% in Group Ib, respectively (p = 0.047, p = 0.027, p = 0.078, and p = 0.012, respectively). Of 618 patients with post-hospital surgery delay, the cumulative mortality rate at 30 days and 12 months was 4.8 and 21.2% in Group IIIa, respectively, and 1.8, and 12.6% in Group IIIb, respectively (p = 0.033 and p = 0.008, respectively). After adjustments, patient factors for delayed surgery (HR 2.780; 95% CI 1.012–7.640, p = 0.047) were significantly associated with death after hip fracture.

Conclusions

This study demonstrated that delayed surgery was significantly related to 30-day and 1-year mortality. Surgery delay due to drugs’ hold and medical comorbidity was related to 30-day mortality after adjustment.

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Acknowledgements

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant Number: HC15C1189).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea

    Yong-Han Cha & Yeon-Seung Min

  2. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea

    Yong-Chan Ha

  3. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea

    Jun-Il Yoo, Young-Kyun Lee & Kyung-Hoi Koo

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  1. Yong-Han Cha
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  2. Yong-Chan Ha
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  3. Jun-Il Yoo
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  4. Yeon-Seung Min
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  6. Kyung-Hoi Koo
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Correspondence to Yong-Chan Ha.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Cha, YH., Ha, YC., Yoo, JI. et al. Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture. Arch Orthop Trauma Surg 137, 625–630 (2017). https://doi.org/10.1007/s00402-017-2674-2

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  • DOI: https://doi.org/10.1007/s00402-017-2674-2

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