Clinical study
The effects of time-to-surgery on mortality and morbidity in patients following hip fracture

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Abstract

Purpose

There is a perception that the standard of care is to repair hip fractures surgically within 24 hours of hospitalization. However, it is unclear whether this reduces mortality or morbidity.

Subjects and methods

We performed a retrospective study in consecutive hip fracture patients, aged 60 years or older, who underwent surgical repair. Patients with metastatic cancer, trauma, or a fracture occurring >48 hours before admission were excluded. The primary outcome was long-term (up to 18 years) mortality. Secondary outcomes included 30-day mortality and decubitus ulcers, serious bacterial infections, myocardial infarction, and thromboembolism. Analyses were adjusted for medical conditions; the comparison group comprised patients who underwent surgery for hip fracture repair within 24 to 48 hours because there were no patients with active medical problems who underwent surgery within 24 hours.

Results

Of the 8383 patients, surgery was delayed for more than 24 hours in 2464 patients (29%) for medical reasons and in 1341 patients (16%) without active medical problems. Compared with those who underwent surgery 24 to 48 hours after admission to the hospital, patients who underwent surgery more than 96 hours after admission did not have increased long-term mortality (hazard ratio = 1.07; 95% confidence interval [CI]: 0.95 to 1.21), although the risk of decubitus ulcer was increased (odds ratio = 2.2; 95% CI: 1.6 to 3.1). There were no associations between time-to-surgery and the other secondary outcomes.

Conclusion

Time-to-surgery in hip fracture patients was not associated with short- or long-term mortality after adjusting for active medical problems. Other than increasing the risk of decubitus ulcer formation, waiting did not appear to affect patients’ outcomes adversely.

Section snippets

Design and sample

We performed a retrospective cohort study using data that had been collected to evaluate the effect of transfusion on mortality and morbidity (15). The sample included consecutive patients with hip fractures who were aged 60 years or older and who underwent surgical repair between 1983 and 1993. Patients were excluded if they had metastatic cancer, trauma resulting in multiple injuries requiring surgery, or declined blood transfusion for religious reasons. For this analysis, we also excluded

Results

Of the 9598 patients who were eligible for the study, we excluded 146 patients because the date of the fracture was missing, 127 because of invalid or missing data about time-to-surgery, and 942 because their fracture occurred either ≥48 hours before admission or following admission to the hospital. The final sample included 8383 patients.

The mean (± SD) age of the cohort was 80.4 ± 8.6 years (range, 60 to 106 years), and almost four fifths were women (Table 1). Most patients were white. Of

Discussion

We evaluated the effect of time-to-surgery on mortality and morbidity in hip fracture patients. In unadjusted analyses, the longer the time-to-surgery, the greater the long-term mortality was observed. However, when we adjusted for demographic characteristics and underlying medical problems, the effect of time-to-surgery was no longer statistically significant, suggesting that time-to-surgery is a marker of comorbidity. We found similar results in the analyses of 30-day mortality and most

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