Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression

Reports Of Original Investigations

Abstract

Purpose: Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians’ guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture.

Methods: Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird random-effects model.

Results: Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI=1.29–1.54,P<0.001), and that for one-year mortality was 1.32 (95% CI=1.21–1.43,P<0.001).

Conclusions: In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young.

Le délai opératoire est-il associé à une mortalité accrue chez les patients atteints d’une fracture de la hanche? Synthèse systématique, méta-analyse et méta-régression

Résumé

Objectif: Le taux de mortalité associée à la fracture de la hanche est élevé chez les patients âgés. Les Directives du Collège royal des médecins recommandent une intervention chirurgicale de réparation de la hanche dans les 24 h suivant l’admission ; cependant, l’effet d’un délai opératoire sur le taux de mortalité demeure controversé. L’objectif de cette étude était de déterminer si un délai opératoire augmentait le taux de mortalité chez les patients âgés souffrant de fracture de la hanche.

Méthode: Les bases de données électroniques nous ont permis d’identifier les comptes-rendus publiés en anglais étudiant l’effet d’un délai chirurgical sur le taux de mortalité des patients subissant une chirurgie de la hanche. Nous avons défini le critère principal comme la mortalité associée à toutes causes à 30 jours et à un an. Les effets de taille avec des intervalles de confiance à 95 % correspondants ont été calculés en utilisant le modèle de DerSimonian-Laird à effets aléatoires.

Résultats: Seize études d’observation prospectives et rétrospectives (257,367 patients) traitant du délai de la chirurgie et du taux de mortalité chez des patients souffrant de fracture de la hanche ont été sélectionnées. Lorsqu’un seuil de 48 h depuis l’heure d’admission du patient était utilisée pour définir le délai opératoire, le rapport de cotes pour la mortalité à 30 jours était de 1,41 (95 % IC=1,29–1,54, P<0,001), et le rapport de cotes pour la mortalité à un an atteignait 1,32 (95 % IC=1,21–1,43, P<0,001).

Conclusions: Chez les patients atteints d’une fracture de la hanche, un délai opératoire de plus de 48 h depuis l’heure d’admission pourrait faire augmenter les risques de mortalité, toutes causes confondues, à 30 jours de 41 %, et de mortalité à un an, toutes causes confondues, de 32 %. Dans les études d’observation, des facteurs confondants résiduels potentiels pourraient empêcher d’arriver à des conclusions définitives. Bien qu’il soit difficile d’effectuer les chirurgies de routine en moins de 48 h dans la plupart des établissements, les anesthésiologistes devraient avoir conscience qu’un délai excessif pourrait être néfaste pour les patients atteints d’une fracture de la hanche, particulièrement pour ceux à faible risque ou qui sont jeunes.

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Copyright information

© Canadian Anesthesiologists 2008

Authors and Affiliations

  1. 1.Second Department of AnesthesiologyToho University School of MedicineTokyoJapan
  2. 2.the Department of AnesthesiaNippon Medical School Chiba Hokusoh HospitalChibaJapan

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