[Medial hip neck fracture: influence of pre-operative delay on the quality of outcome. Results of data from the external in-hospital quality assurance within the framework of secondary data analysis]

Abstract

Problem: According to international and national studies and clinical guidelines, patients with medial hip neck fracture should receive surgery as soon as medically reasonable after hospitalization, preferably within 48 h. Analysis of the German quality registry data of 2006 showed, however, that in 13 out of the 16 federal states less than 85% of patients were operated on within 48. Delayed surgery was found especially during the weekend.

Objective: The objective of the study was to examine whether German data confirm that a short preoperative waiting time after hip fracture improves the outcome. The study was commissioned by the Federal Joint Committee (G-BA) and was jointly performed by the German Society for Accident Surgery (DGU) and the National Institute for Quality in Healthcare (BQS).

Data and methods: The analysis is based on the data of the nationwide quality registry of the years 2004-2006. Out of a total of 129,075 patients with a medial hip neck fracture 22,171 received operative treatment later than 48 h after hospital admission. Comparable study groups were constructed with the help of a propensity score (1-to-1 matching). Study and control groups only differed in terms of delay of surgery. The comparison concerning the outcomes was made with the Fisher exact test (bilateral).

Results: In the group of patients with a delay of surgery longer than 48 h significantly higher rates of surgical complications (OR 1.10), general complications (OR 1.09) and pressure ulcers (1.27) were observed (all p<0.001). The in-hospital mortality showed no significant difference (OR 0.96, p=0.302).

Conclusions: Patients with medial hip neck fracture should receive operative treatment without delay, if no medical contra-indications for immediate surgery. In particular appropriate organizational measures should be taken to ensure an early surgical treatment even during weekends.