Delay to surgery and mortality after hip fracture

Abstract

Background: Hip fractures in elderly patients are associated with increased mortality. These patients frequently experience a delay to surgery for both medical and non-medical reasons. The effect of this delay on patient morbidity and mortality is controversial.

Methods: We conducted an observational study of 222 consecutive patients greater than 50 years of age who underwent surgical management of a hip fracture at one tertiary hospital. Baseline measures recorded were age, sex, time to theatre, American Society of Anesthesiology (ASA) scores, type of surgery, number of theatre cancellations and the reason for any cancellation. Our primary outcome was 30-day mortality after surgery.

Results: The 30-day mortality after hip fracture was 7.2%. Patients who were operated on within 2 days of admission had a 30-day postoperative mortality rate of 5.8% versus 9.4% in those patients who experience a delay of more than 2 calendar days. This was not a statistically significant difference, and the effect of surgical delay was less on multivariate analysis. In multivariate analysis, the only statistically significant predictors of 30-day mortality were an increasing ASA score and having a fracture treated with an arthroplasty procedure.

Conclusions: Our study did not show a significant increase in mortality in patients whose surgery was delayed by more than 2 days. However, in the context of other published work, we would continue to recommend early surgery to minimize length of stay and complications.