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. 2013 Dec;4(4):109-16.
doi: 10.1177/2151458513518344.

Surgical time of day does not affect outcome following hip fracture fixation

Julie A Switzer  1 , Ryan E Bennett  1 , David M Wright  1 , Sandy Vang  1 , Christopher P Anderson  2 , Andrea J Vlasak  1 , Steven R Gammon  3
Affiliations

Surgical time of day does not affect outcome following hip fracture fixation

Julie A Switzer et al. Geriatr Orthop Surg Rehabil. 2013 Dec.

Abstract

Background: Due to the need for medical optimization and congested operating room schedules, surgical repair is often performed at night. Studies have shown that work done at night increases complications. The primary aim of our study is to compare the rates of complications and 30-day mortality between 2 surgical times of day, daytime group (DTG, 07:00-15:59) and nighttime group (NTG, 16:00-06:59).

Methods: Retrospective chart review from 2005 through 2010.

Setting: Level 1 Trauma Center.

Participants: 1443 patients with hip fracture, age ≥50 years with isolated injury and surgical treatment of the fracture.

Main outcomes and measures: Thirty-day mortality and complications: myocardial infarction, cardiac event, stroke, central nervous system event, pneumonia, urinary tract infection, postoperative wound infection, and bleeding requiring transfusion of 3 or more red blood cell units.

Results: A total of 859 patients met the inclusion criteria; 668 patients in the DTG and 191 patients in the NTG. The 30-day mortality was 7.8%. The complication rate was 28%. No difference was found in 30-day mortality or complication rate based on the time of day the surgery was performed (P = 1.0 and P = .92, respectively). This remained unchanged when controlling for health status and surgical complexity. Age (odds ratio = 1.03/year), Charlson Comorbidity Index (CCI; odds ratio = 1.21), and American Society of Anesthesiologists (ASA; odds ratio = 1.85) score were predictive of adverse outcomes.

Conclusion: Surgical time of day did not affect 30-day mortality or total number of complications. Age, ASA score, and CCI were associated with adverse outcomes.

Keywords: geriatric; hip fracture; outcomes; surgery time; time of day; time to operation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Receiver–operating characteristic (ROC) curve analysis was used to compare 4 possible sets of prognostic indicators (listed in the legend) for complications. Of the 4 models analyzed, the greatest predictors of adverse outcomes (mortality and complications) were age, ASA score, and Charlson comorbidity index. Surgical time of day was not predictive of adverse outcomes.
Figure 2.
Figure 2.
Patient cohort—retrospective chart review was performed for patients (>50 years old) surgically treated for a hip fracture from January 1, 2005 to December 31, 2010 at a Level I trauma center via screening for Current Procedural Terminology (CPT) code. Of the 859 included patients, 247 (28.8%) underwent hemiarthroplasty, 240 (27.9%) underwent fixation with an intramedullary nail, 184 (21.4%) underwent open reduction and internal fixation with a sliding hip screw, 81 (9.4%) underwent a total hip arthroplasty, 73 (8.5%) underwent closed reduction and percutaneous fixation with cannulated screws, and 34 (4.0%) underwent open reduction and internal fixation (ORIF) with a device other than sliding hip screw (blade plate or proximal femoral locking plate). There was no statistical difference in rates of each fracture (p=0.732) or repair type (p=0.444) between the DTG and NTG.
Figure 3.
Figure 3.
A histogram of surgical start time shows that 668 patients underwent surgery in the daytime group (DTG) 07:00-15:59, while 191 underwent surgery in the nighttime group (NTG) from 16:00-06:59.
Figure 4.
Figure 4.
A Kaplan-Meier plot of hospital length of stay (LOS) by surgical daytime group (DTG) and nighttime group (NTG) illustrates that patients in the DTG had a longer length of hospital stay compared to those in the NTG.
See this image and copyright information in PMC

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