Abstract
Background. The prevalence of hip fractures is steadily increasing, as the population ages. These fractures are associated with significant morbidity and mortality. Most of these fractures are treated surgically. Factors related to surgical intervention can play a significant role in the outcome.
This study examines the association of in-hospital mortality with the timing of surgery, sex, and age of patients treated surgically due to a hip fracture at Clinical Hospital Shtip in a 2-year long period.
Material and Methods. A total of 348 patients admitted with a diagnosis of hip fracture who were treated surgically were identified. Data about sex and age were collected. The outcome was assessed for groups treated within 24, 48, 72, and more than 72 hours after admission. Descriptive statistical methods, chi-square test, t-test for independent samples, and odds - ratio with 95% confidence interval (CI) were used in statistical analysis.
Results. The delay of surgical treatment beyond 24 hours did not increase the risk of death (OR=0.65, 95%CI=0.23-1.73). Delays beyond 48h and 72h increased the risk of death progressively (OR=1.17, 95%CI=0.50-2.75, and OR=1.65, 95%CI=0.69-3.95 respectively). Mortality was significantly higher in the 76-85-years age group.
Conclusions. Association between surgical delay and in-hospital mortality in hip fracture patients is disputed. Confounding factors such as age, sex, comorbidities, and type of treatment determine the outcome. Patients with hip fractures, without any additional disease, should be operated on as soon as possible after admission to the hospital. Delay beyond 48 hours may increase the risk for in-hospital mortality.
References
Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-413. doi:10.1007/PL00004148
Sernbo I, Johnell O. Consequences of a hip fracture: A prospective study over 1 year. Osteoporos Int. 1993;3(3):148-153. doi:10.1007/BF01623276
Jiang HX, Majumdar SR, Dick DA, et al. Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res. 2005;20(3):494-500. doi:10.1359/JBMR.041133
Moja L, Piatti A, Pecoraro V, et al. Timing Matters in Hip Fracture Surgery: Patients Operated within 48 Hours Have Better Outcomes. A Meta-Analysis and Meta-Regression of over 190,000 Patients. PLoS One. 2012;7(10). doi:10.1371/journal.pone.0046175
Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: Observational study. Br Med J. 2006;332(7547):947-950. doi:10.1136/bmj.38790.468519.55
Novack V, Jotkowitz A, Etzion O, Porath A. Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Heal Care. 2007;19(3):170-176. doi:10.1093/intqhc/mzm003
Daugaard CL, Jorgensen HL, Riis T, Lauritzen JB, Duus BR, Van Der Mark S. Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays? A retrospective study of 38,020 patients. Acta Orthop. 2012;83(6):609-613. doi:10.3109/17453674.2012.747926
Bergeron E, Lavoie A, Moore L, et al. Is the delay to surgery for isolated hip fracture predictive of outcome in efficient systems? J Trauma - Inj Infect Crit Care. 2006;60(4):753-757. doi:10.1097/01.ta.0000214649.53190.2a
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(9):702-709. doi:10.1016/S0002-9343(02)01119-1
Alzahrani K, Gandhi R, Davis A, Mahomed N. In-hospital mortality following hip fracture care in southern Ontario. Can J Surg. 2010;53(5):294-298. https://pubmed.ncbi.nlm.nih.gov/20858372/. Accessed May 17, 2021.
Weller I, Wai EK, Jaglal S, Kreder HJ. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Jt Surg - Ser B. 2005;87(3):361-366. doi:10.1302/0301-620X.87B3.15300
INDICADORES DE CALIDAD PARA HOSPITALES DEL SISTEMA NACIONAL DE SALUD.; 2012. www.calidadasistencial.es. Accessed May 17, 2021.
AHRQ Quality Indicators Guide to Inpatient Quality Indicators: Quality of Care in Hospitals-Volume, Mortality, and Utilization.; 2002. http://www.qualityindicators.ahrq.gov. Accessed May 17, 2021.
Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: A function of patient characteristics. In: Clinical Orthopaedics and Related Research. Lippincott Williams and Wilkins; 2004:64-71. doi:10.1097/01.blo.0000132406.37763.b3
Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Morality risk after hip fracture. J Orthop Trauma. 2003;17(1):53-56. doi:10.1097/00005131-200301000-00008
Giversen IM. Time trends of mortality after first hip fractures. Osteoporos Int. 2007;18(6):721-732. doi:10.1007/s00198-006-0300-1
Meyer HE, Tverdal A, Falch JA, Pedersen JI. Factors associated with mortality after hip fracture. Osteoporos Int. 2000;11(3):228-232. doi:10.1007/s001980050285
Diamantopoulos AP, Hoff M, Hochberg M, Haugeberg G. Predictors of short- and long-term mortality in males and females with hip fracture - a prospective observational cohort study. PLoS One. 2013;8(10). doi:10.1371/journal.pone.0078169
Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen T V. Risk factors for in-hospital post-hip fracture mortality. Bone. 2011;49(3):553-558. doi:10.1016/j.bone.2011.06.002
Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ. Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Jt J. 2015;97-B(2):246-251. doi:10.1302/0301-620X.97B2.35248
Belmont PJ, Garcia EJ, Romano D, Bader JO, Nelson KJ, Schoenfeld AJ. Risk factors for complications and in-hospital mortality following hip fractures: A study using the National Trauma Data Bank. Arch Orthop Trauma Surg. 2014;134(5):597-604. doi:10.1007/s00402-014-1959-y
Trpeski S, Kaftandziev I, Kjaev A. The effects of time-to-surgery on mortality in elderly patients following hip fractures. Pril (Makedonska Akad na Nauk i Umet Oddelenie za Med Nauk. 2013;34(2):115-121. http://www.ncbi.nlm.nih.gov/pubmed/24280786.
Panula J, Pihlajamäki H, Mattila VM, et al. Mortality and cause of death in hip fracture patients aged 65 or older - A population-based study. BMC Musculoskelet Disord. 2011;12. doi:10.1186/1471-2474-12-105
Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: A systematic review and meta-analysis. Age Ageing. 2014;43(4):464-471. doi:10.1093/ageing/afu065
Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: A systematic review and meta-analysis. Injury. 2012;43(6):676-685. doi:10.1016/j.injury.2011.05.017
Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery).(...). J Am Coll Cardiol. 2007;50(17):1707-1732. doi:10.1016/j.jacc.2007.09.001
Schilling P, Goulet JA, Dougherty PJ. Do higher hospital-wide nurse staffing levels reduce in-hospital mortality in elderly patients with hip fractures: A pilot study. Clin Orthop Relat Res. 2011;469(10):2932-2940. doi:10.1007/s11999-011-1917-8
Browne JA, Pietrobon R, Olson SA. Hip fracture outcomes: Does surgeon or hospital volume really matter? J Trauma - Inj Infect Crit Care. 2009;66(3):809-814. doi:10.1097/TA.0b013e31816166bb
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