Preoperative Testing for Hip Fracture Patients Delays Surgery, Prolongs Hospital Stays, and Rarely Dictates Care

Abstract

Objectives: To determine how often preoperative testing is requested for geriatric hip fracture patients, to assess the extent to which preoperative testing is associated with delayed surgery, and to measure the frequency with which preoperative testing changes patient management.

Design: Retrospective.

Setting: Academic health system.

Patients: Two hundred fifty consecutive geriatric hip fracture patients admitted through the emergency department and underwent surgery.

Intervention: Hip fracture surgery.

Main outcome measurements: The patients were categorized according to whether additional preoperative tests were requested. For each patient, the times of presentation and surgery were recorded, yielding a "time-to-surgery interval." The results of any tests, the actions resulting from testing, and the length of hospital stay were also noted.

Results: Additional preoperative testing was performed for 67 patients (27%). For those patients, the mean time-to-surgery was 73 hours. For the 183 patients who had no testing, the mean time-to-surgery was 37 hours. Moreover, 42 of the 67 patients with testing (63%) had time-to-surgery greater than 48 hours, compared with only 37 of the 183 (20%) patients without testing. The mean length of stay for tested patients was 12.0 days compared with 9.0 days for nontested patients. In only 2 of the 67 tested patients was further care offered based on the test result.

Conclusions: Testing was associated with greater time-to-surgery and length of stay. Furthermore, testing rarely influenced management. Patients might be able to have surgery more expeditiously and leave the hospital earlier if testing were deferred.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.