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. 2008 Feb;32(1):13-8.
doi: 10.1007/s00264-006-0290-9. Epub 2007 Jan 12.

Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients

D O F Verbeek  1 , K J Ponsen, J C Goslings, M J Heetveld
Affiliations

Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients

D O F Verbeek et al. Int Orthop. 2008 Feb.

Abstract
in English, French

Previous studies have not demonstrated consistent results on the effect of surgical delay on outcome. This study investigated the association between the delay to surgery and the development of postoperative complications, length of hospital stay (LOS) and one-year mortality. Patients that underwent surgery for a hip fracture in a two-year period were included in a retrospective study. Uni- and multivariate regression analysis was performed in 192 hip fracture patients. There was a trend towards fewer postoperative complications (P = 0.064; multivariate regression, MR) and shorter LOS (P = 0.088; MR) in patients with a delay of less than one day to surgery. No association between surgical delay and one-year mortality was found in the population as a whole (P = 0.632; univariate regression, UR). Delay to surgery beyond one day was associated with an increased risk of infectious complications (P = 0.004; MR). In ASA I and II class patients, operation beyond one day from admission was associated with an increased risk of one-year mortality (P = 0.03; MR) and more postoperative infectious complications (P = 0.02; MR). The trends towards fewer complications and shorter LOS suggest that early surgery (within one day from admission) is beneficial for hip fracture patients who are able to undergo an operation.

Certaines études n’ont pas mis en évidence de résultats probants à propos de la prise en charge chirurgicale retardée des fractures du col fémoral. Cette étude a pour but de mettre en évidence la relation entre les complications chirurgicales et le délai de la prise en charge, la durée moyenne de séjour (DMS), et la mortalité à un an. Les patients qui ont bénéficié d’une prise en charge chirurgicale pour une fracture de la hanche dans les deux années précédentes ont été inclus dans une étude rétrospective. Une étude avec régression multi variable a été réalisée pour 192 hanches fracturées. Il y a moins de complications post opératoires et une DMS plus courte (P = 0.088) chez les patients dont le délai de prise en charge est inférieur à un jour. Nous n’avons pas retrouvé de relations entre le délai de prise en charge et la mortalité à 1 an. Nous n’avons pas trouvé non plus de relation entre le délai de prise en charge et la mortalité à 1 an. Quand la chirurgie est réalisée plus d’un jour après le traumatisme, le taux de complications infectieuses augmentent (P = 0.004 MR). Chez les patients de classe ASA I et ASA II une prise en charge chirurgicale réalisée au-delà d’un jour après l’entrée dans le service est en relation avec une augmentation du risque de mortalité à 1 an (P = 0.03) et du nombre de complications infectieuses (P = 0.02). En conclusion, nous pouvons affirmer qu’afin de diminuer les complications, de raccourcir la durée moyenne du séjour chez ces patients, il est nécessaire qu’ils bénéficient d’une prise en charge chirurgicale inférieure à 1 jour après leur hospitalisation.

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