Abstract
Introduction
The relationship between the timing of surgery after hip fracture and the subsequent survival of the patient has been studied extensively, yet still remains a controversy. This study aims to assess the impact of operative delay on the 1-year survival of patients and on the rate of complications during the postoperative hospital stay.
Materials and methods
Medical and demographic data were extracted from the hospital records of 651 consecutive hip fracture patients over 60 years old. Information on mortality was obtained by cross-linkage with the Department of Interior population files. The multivariate survival analysis model was utilized to assess the association between the time from fracture incident to surgery and the outcome (1-year survival and postoperative complications).
Results
The hazard ratio (HR) of 1-year mortality for postponing surgery beyond 48 h was 1.63 (95%CI 1.11–2.40), as derived by the Cox proportional hazards model. Other variables found to be independently associated with decreased survival are: male gender (HR=1.54), mental deterioration (HR=2.94), postoperative mobility (HR=2.45), and severity of pre-existing diseases (HR=1.96). Occurrence of general complications during the postoperative hospital stay was a significant predictor of decreased 1-year survival (HR=1.83).
Conclusion
These findings suggest that early (within 48 h) surgical treatment of hip fractures is associated with improved 1-year survival.
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References
Baker SP, Harvey AH (1985) Falls in the elderly. Clin Geriatr Med 1:501–512
Beloosesky Y, Hendel D, Hershkovitz A, Skribnic G, Grinblat J (2001) Outcome of medically unstable elderly patients admitted to a geriatric ward after hip fracture. Aging 13:78–84
Bhattacharyya T, Iorio R, Healy WL (2002) Rate of and risk factors for acute inpatient mortality after orthopaedic surgery. J Bone Joint Surg Am 84:562–572
Bredahl C, Nyholm B, Hindsholm KB, Mortensen JS, Olesen AS (1992) Mortality after hip fracture: results of operation within 12 h of admission. Injury 23:83–86
Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S-17S
Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton-LJ 3d (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005
Cumming RG, Nevitt MC, Cummings SR (1997) Epidemiology of hip fractures. Epidemiol Rev 19:244–257
Dahl E (1980) Mortality and life expectancy after hip fractures. Acta Orthop Scand 51:163–170
Davidson TI, Bodey WN (1986) Factors influencing survival following fractures of the upper end of the femur. Injury 17:12–14
Davis FM, Woolner DF, Frampton C et al (1987) Prospective, multi-center trial of mortality following general or spinal anaesthesia for hip fracture in the elderly. Br J Anaesth 59:1080–1088
Davis TR, Sher JL, Porter BB, Checketts RG (1988) The timing of surgery for intertrochanteric femoral fractures. Injury 19:244–246
Dennison E, Cooper C (2000) Epidemiology of osteoporotic fractures. Horm Res 54 [Suppl 1]:58–63
Dolk T (1990) Operation in hip fracture patients—analysis of the time factor. Injury 21:369–372
Dripps RD, Lamont A, Eckenhoff JE (1961) The role of anesthesia in surgical mortality. JAMA 178:261–266
Eiskjaer S, Ostgard SE (1991) Risk factors influencing mortality after bipolar hemiarthroplasty in the treatment of fracture of the femoral neck. Clin Orthop 270:295–300
Eshkenazi AU, Lokiec F, Giveon U, Horoszowski H, Malkin C, Weigl K (1991) Fractures of the proximal femur. Harefuah 121:79–83
Forster MC, Calthorpe D (2000) Mortality following surgery for proximal femoral fractures in centenarians. Injury 31:537–539
Fox HJ, Pooler J, Prothero D, Bannister GC (1994) Factors affecting the outcome after proximal femoral fractures. Injury 25:297–300
Grisso JA, Kelsey JL, Strom BL et al (1991) Risk factors for falls as a cause of hip fracture in women. N Engl J Med 324:1326–1331
Guyton JL (1998) Fractures of hip, acetabulum and pelvis. In: Canale ST (ed) Campbell’s operative orthopaedics, 9th edn. Mosby, St. Louis, pp 2181–2183
Hamilton BH, Hamilton VH, Mayo NE (1996) What are the costs of queuing for hip fracture surgery in Canada? J Health Econ 15:161–185
Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE (1997) Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop 26:621–627
Hefley FG Jr, Nelson CL, Puskarich-May CL (1996) Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Joint Surg Am 78:581–583
Hoerer D, Volpin G, Stein H (1993) Results of early and delayed surgical fixation of hip fractures in the elderly: a comparative retrospective study. Bull Hosp Jt Dis 53:29–33
Kenzora JE, McCarthy RE, Drennan Lowell J, Sledge CB (1984) Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop 186:45–56
Kleinbaum DG (1996) Survival analysis. A self-learning text. Springer, Berlin Heidelberg New York
Koval KJ, Zuckerman JD (1994) Hip fractures. I. Overview and evaluation and treatment of femoral-neck fractures. J Am Acad Orthop Surg 2:141–149
Lyons AR (1997) Clinical outcomes and treatment of hip fractures. Am J Med 103:51S-63S
Morris AH, Zuckerman JD (2002) National Consensus Conference on Improving the Continuum of Care for Patients with Hip Fracture. J Bone Joint Surg Am 84:670–674
Mullen JO, Mullen NL (1992) Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop 280:214–222
Nightingale S, Holmes J, Mason J, House A (2001) Psychiatric illness and mortality after hip fracture. Lancet 357:1264–1265
Perez JV, Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femur fracture—an autopsy study. Injury 26:237–240
Poor G, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1995) Determinants of reduced survival following hip fractures in men. Clin Orthop 319:260–265
Sexson SB, Lehner JT (1987) Factors affecting hip fracture mortality. J Orthop Trauma 1:298–305
Sherk HH, Snape WJ, Loprete FL (1979) Internal fixation versus non-treatment of hip fractures in senile patients. Clin Orthop 141:196–198
Todd CJ, Freeman CJ, Camilleri-Ferrante C et al (1995) Differences in mortality after fracture of hip: the East Anglian audit. BMJ 310:904–908
Walter LC, Lui LY, Eng C, Covinsky KE (2003) Risk of hip fracture in disabled community-living older adults. J Am Geriatr Soc 5:50–55
White BL, Fisher WD, Laurin CA (1987) Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg Am 69:1335–1340
Zuckerman JD (1996) Hip fracture. N Engl J Med 334:1519–1525
Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH (1995) Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 77:1551–1556
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Gdalevich, M., Cohen, D., Yosef, D. et al. Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 124, 334–340 (2004). https://doi.org/10.1007/s00402-004-0662-9
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DOI: https://doi.org/10.1007/s00402-004-0662-9