Abstract
Summary
This study aims to analyze whether the interval from hospital admission to surgery may be used as a surrogate of the actual gap from fracture to surgery when investigating in-hospital hip fracture mortality. After analyzing 3,754 hip fracture admissions, we concluded that those intervals might be used interchangeably without misinterpretation bias.
Introduction
The debate regarding the influence of time to surgery in hip fracture (HF) mortality is one of the most controversial issues in the HF medical literature. Most previous investigations actually analyzed the time from hospital admission to surgery as a surrogate of the less easily available gap from fracture to surgery. Notwithstanding, the assumption of equivalency between those intervals remains untested.
Methods
We analyzed 3,754 hospital admissions of elderly patients due to HF in Quebec, Canada. We compared the performance as predictors of in-hospital mortality of the delay from admission to surgery and the actual gap from fracture to surgery using univariate and multiple logistic regression analysis.
Results
The mean times from fracture to surgery and from admission to surgery were 1.84 and 1.02 days (P < 0.001), respectively. On univariate logistic regression, both times were slightly significant as mortality predictors, yielding similar odds ratios of 1.08 (P < 0.001) for time from fracture to surgery and 1.11 (P < 0.001) for time from admission to surgery. After accounting for other covariates, neither times remained significant mortality predictors.
Conclusion
The gap from admission to surgery may be used as a surrogate of the actual delay from fracture to surgery when studying in-hospital HF mortality.
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References
Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL (2002) The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 112:702–709
Majumdar SR, Beaupre LA, Johnston DW, Dick DA, Cinats JG, Jiang HX (2006) Lack of association between mortality and timing of surgical fixation in elderly patients with hip fracture: results of a retrospective population-based cohort study. Med Care 44:552–559
McGuire K, Bernstein J, Polsky D, Silber J (2004) Delays until surgery after hip fracture increases mortality. Clin Orthop Rel Res 428:294–301
Rae HC, Harris IA, McEvoy L, Todorova T (2007) Delay to surgery and mortality after hip fracture. ANZ J Surg 77:889–891
Novack V, Jotkowitz A, Etzion O, Porath A (2007) Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Health Care 19:170–176
Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332:947–951
Doruk H, Mas MR, Yildiz C, Sonmez A, Kyrdemir V (2004) The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr 39:179–185
Gdalevich M, Cohen D, Yosef D, Tauber C (2004) Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 124:334–340
Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489
Weller I, Wai EK, Jaglal S, Kreder HJ (2005) The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br 87:361–366
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
Casaletto JA, Gatt R (2004) Post-operative mortality related to waiting time for hip fracture surgery. Injury 35:114–120
Villar RN, Allen SM, Barnes SJ (1986) Hip fractures in healthy patients: operative delay versus prognosis. Br Med J (Clin Res Ed) 293:1203–1204
Orosz GM, Hannan EL, Magaziner J, Koval K, Gilbert M, Aufses A, Straus E, Vespe E, Siu AL (2002) Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc 50:1336–1340
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
Dolk T (1990) Operation in hip fracture patients—analysis of the time factor. Injury 21:369–372
D’Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49:1429–1433
Levy AR, Tamblyn RM, Fitchett D, McLeod PJ, Hanley JA (1999) Coding accuracy of hospital discharge data for elderly survivors of myocardial infarction. Can J Cardiol 15:1277–1282
R Development Core Team (2008) R: A Language and Environment for Statistical Computing. In. R Foundation for Statistical Computing, Vienna, Austria. Available at: http://www.R-project.org
Camargo KR Jr., Coeli CM (2006) CalcCharlson v1.1. Available at http://www.iesc.ufrj.br/reclink/. Accessed March 30, 2008
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
Kenzora JE, McCarthy RE, Lowell JD, Sledge CB (1984) Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 186:45–56
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
Davis FM, Woolner DF, Frampton C, Wilkinson A, Grant A, Harrison RT, Roberts MT, Thadaka R (1987) Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth 59:1080–1088
Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56:788–795
Ho V, Hamilton BH, Roos LL (2000) Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada. Health Serv Res 34:1499–1518
Perez JV, Warwick DJ, Case CP, Bannister GC (1995) Death after proximal femoral fracture: an autopsy study. Injury 26:237–240
Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, Parker MJ, Payne BV, Rushton N (1995) Differences in mortality after fracture of hip: the east Anglian audit. Bmj 310:904–908
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
Harty JA, McKenna P, Moloney D, D’Souza L, Masterson E (2007) Anti-platelet agents and surgical delay in elderly patients with hip fractures. J Orthop Surg (Hong Kong) 15:270–272
Rogers FB, Shackford SR, Keller MS (1995) Early fixation reduces morbidity and mortality in elderly patients with hip fractures from low-impact falls. J Trauma 39:261–265
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
Davis TR, Sher JL, Porter BB, Checketts RG (1988) The timing of surgery for intertrochanteric femoral fractures. Injury 19:244–246
Franzo A, Francescutti C, Simon G (2005) Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 20:985–991
Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K (1997) What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med 157:513–520
Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL (2004) Association of timing of surgery for hip fracture and patient outcomes. Jama 291:1738–1743
Stoddart J, Horne G, Devane P (2002) Influence of preoperative medical status and delay to surgery on death following a hip fracture. ANZ J Surg 72:405–407
Parker MJ, Pryor GA (1992) The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br 74:203–205
Sund R, Liski A (2005) Quality effects of operative delay on mortality in hip fracture treatment. Qual Saf Health Care 14:371–377
Shiga T, Wajima Z, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression: [Le delai operatoire est-il associe a une mortalite accrue chez les patients atteints d’une fracture de la hanche ? Synthese systematique, meta-analyse et meta-regression]. Can J Anaesth 55:146–154
Bryson GL (2008) Waiting for hip fracture repair—Do outcomes and patients suffer?/En attendant une chirurgie pour fracture de la hanche: est-ce que les patients et leur evolution en patissent? Can J Anaesth 55:135–139
Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79:274–278
Bhandari M, Tornetta P 3rd, Ellis T, Audige L, Sprague S, Kuo JC, Swiontkowski MF (2004) Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures. Arch Orthop Trauma Surg 124:10–16
Vidal EI, Coeli CM, Pinheiro RS, Camargo KR Jr. (2006) Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil. Osteoporos Int 17:1569–1576
Acknowledgments
We are grateful to Michèle Paré, analyst at the GRIS, University of Montreal, for her assistance with the preparation of the MED-ECHO database. Three authors (DCMF, CMC, and KRCJ) were partially supported by research fellowship grants from the Brazilian National Council for Scientific and Technological Development (CNPq). FBF was supported by a research fellowship grant from the State of São Paulo Foundation for Research Support (FAPESP).
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Vidal, E.I.O., Moreira-Filho, D.C., Coeli, C.M. et al. Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?. Osteoporos Int 20, 723–729 (2009). https://doi.org/10.1007/s00198-008-0757-1
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DOI: https://doi.org/10.1007/s00198-008-0757-1