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The timing of surgery and mortality in elderly hip fractures

A retrospective, multicenteric cohort study

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Abstract

Background

Early surgery is recommended for elderly hip fracture patients, but some studies show no clear advantage. The benefits of early surgery may differ according to the medical environment in different countries. The purpose of this study was to identify the potential benefits of early surgery in elderly hip fracture patients by evaluating the effect of timing of surgery on mortality.

Materials and Methods

A retrospective study was conducted at multiple centers on hip fracture patients aged over 65 years. The primary outcome was 1 year mortality and the secondary outcomes were 30-day/6-month mortality and complications during admission. The effect of time to surgery on mortality was analyzed using a Cox proportional-hazards model.

Results

Among the 874 patients, 162 (18.5%) received surgery within 3 days and their 1-year mortality rate was 9.9%. However, the 1-year mortality rate for the delayed surgery group was 12.5%. After adjustment for potential confounders, the 1-year mortality rates in patients who received surgery in 3-7 days (Hazard ratio = 1.0; 95% confidence interval [CI]: 0.7-1.6) and over 7 days (hazard ratio = 1.3; 95% CI: 0.9-1.8) were not significantly different. In addition, the time to surgery did not have a significant effect on 30-day mortality, 60-day mortality or complications arising during hospitalization.

Conclusions

The time to surgery did not affect short and long term mortality or the in hospital complication rate in elderly hip fracture patients. We recommend concentrating more on optimizing the condition of patients early with sufficient medical treatment rather than being bound by absolute timing of surgery.

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References

  1. Cooper C. Epidemiology of osteoporosis. OsteoporosInt 1999;9 Suppl 2:S2–8.

    Article  Google Scholar 

  2. Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: Observational study. BMJ 2006;332:947–51.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Davis TR, Sher JL, Porter BB, Checketts RG. The timing of surgery for intertrochanteric femoral fractures. Injury 1988;19:244–6.

    Article  CAS  PubMed  Google Scholar 

  4. Dolk T. Influence of treatment factors on the outcome after hip fractures. Ups J Med Sci 1989;94:209–21.

    Article  CAS  PubMed  Google Scholar 

  5. Paksima N, Koval KJ, Aharanoff G, Walsh M, Kubiak EN, Zuckerman JD, et al. Predictors of mortality after hip fracture: A 10-year prospective study. Bull NYU Hosp Jt Dis 2008;66:111–7.

    PubMed  Google Scholar 

  6. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, et al. Effect of early surgery after hip fracture on mortality and complications: Systematic review and meta-analysis. CMAJ 2010;182:1609–16.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Al-Omran A, Sadat-Ali M. Is early mortality related to timing of surgery after fracture femur in the elderly? Saudi Med J 2006;27:507–10.

    PubMed  Google Scholar 

  8. Librero J, Peiró S, Leutscher E, Merlo J, Bernal-Delgado E, Ridao M, et al. Timing of surgery for hip fracture and in-hospital mortality: A retrospective population-based cohort study in the Spanish National Health System. BMC Health Serv Res 2012;12:15.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lyons AR. Clinical outcomes and treatment of hip fractures. Am J Med 1997;103:51S–63.

    Article  CAS  PubMed  Google Scholar 

  10. Mackenzie DG, Wild S, Muir R. Mortality associated with delay in operation after hip fracture: Scottish data provide additional information. BMJ 2006;332:1093.

    PubMed  PubMed Central  Google Scholar 

  11. Yeranosian M, Horneff JG, Baldwin K, Hosalkar HS. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: A systematic review. Bone Joint J 2013;95-B:135–42.

    Article  CAS  PubMed  Google Scholar 

  12. Sebestyén A, Boncz I, Sándor J, Nyárády J. Effect of surgical delay on early mortality in patients with femoral neck fracture. IntOrthop 2008;32:375–9.

    Google Scholar 

  13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373–83.

    Article  CAS  PubMed  Google Scholar 

  14. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: A study of consistency of ratings. Anesthesiology 1978;49:239–43.

    Article  CAS  PubMed  Google Scholar 

  15. Kitamura S, Hasegawa Y, Suzuki S, Sasaki R, Iwata H, Wingstrand H, et al. Functional outcome after hip fracture in Japan. ClinOrthopRelat Res 1998;348:29–36.

    Google Scholar 

  16. Korea S. Death statistics, 2011. Available from: http://www.kostat.go.kr/portal/english/index.action. [Last accessed on 2012 Dec 31].

    Google Scholar 

  17. Grimes JP, Gregory PM, Noveck H, Butler MS, Carson JL. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med 2002;112:702–9.

    Article  PubMed  Google Scholar 

  18. Manninger J, Kazar G, Fekete G, Fekete K, Frenyo S, Gyarfas F, et al. Significance of urgent (within 6 h) internal fixation in the management of fractures of the neck of the femur. Injury 1989;20:101–5.

    Article  CAS  PubMed  Google Scholar 

  19. Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004;291:1738–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Avenell A. Differences in mortality after fracture of hip. Patient’s nutritional status is not recorded. BMJ 1995;311:572.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Beringer TR, Crawford VL, Brown JG. Audit of surgical delay in relationship to outcome after proximal femoral fracture. Ulster Med J 1996;65:32–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Dorotka R, Schoechtner H, Buchinger W. Influence of nocturnal surgery on mortality and complications in patients with hip fractures. Unfallchirurg 2003;106:287–93.

    Article  CAS  PubMed  Google Scholar 

  23. Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE. Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop (Belle Mead NJ) 1997;26:621–7.

    CAS  Google Scholar 

  24. Parker MJ, Pryor GA. The timing of surgery for proximal femoral fractures. J Bone Joint Surg Br 1992;74:203–5.

    Article  CAS  PubMed  Google Scholar 

  25. Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 1995;77:1551–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea

    Euichung Kim

  2. Department of Orthopaedics, College of Medicine, Hanyang University, Seoul, South Korea

    Young Jeon Shin & Bo Youl Choi

  3. Departments of Emergency Medicine, CHA University, Seoul, South Korea

    Young Ho Kim

  4. Departments of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea

    Hyuk Joong Choi &  Tae Ho Lim

Authors
  1. Hyuk Joong Choi
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  2. Euichung Kim
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  3. Young Jeon Shin
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  4. Bo Youl Choi
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  5. Young Ho Kim
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Correspondence to Tae Ho Lim.

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Choi, H.J., Kim, E., Shin, Y.J. et al. The timing of surgery and mortality in elderly hip fractures. IJOO 48, 599–604 (2014). https://doi.org/10.4103/0019-5413.144232

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  • DOI: https://doi.org/10.4103/0019-5413.144232

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