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. 2020 Sep;90(9):1750-1753.
doi: 10.1111/ans.16115. Epub 2020 Jul 30.

Time to surgery and transfer-associated mortality for hip fractures in Western Australia

Adam M Lawless  1 , Siddarth Narula  1 , Peter D'Alessandro  1 , Christopher W Jones  1 , Hannah Seymour  2 , Piers J Yates  1
Affiliations

Time to surgery and transfer-associated mortality for hip fractures in Western Australia

Adam M Lawless et al. ANZ J Surg. 2020 Sep.

Abstract

Background: Transfer time for patients with fractured hips is a significant problem in Australia. Current guidelines support operative management of hip fractures within 48 h with delays to surgery resulting in worse outcomes. The aim of study is to evaluate transfer times and delays and their effect on outcomes.

Methods: A total of 506 hip fractures undergoing surgical management were reviewed between 2017 and 2018 at a tertiary metropolitan hospital. We examined age, time to surgery, transfer time, delay to surgery, American Society of Anesthesiologists grading and 30-day and 1-year mortality. We directly compared outcomes between patients presenting initially to the tertiary hospital and those who were referred from a peripheral site requiring inter-hospital transfer.

Results: The mean time to surgery was 24.4 h. Ninety-five percent of patients received their emergency surgery within 48 h with inter-hospital transfer patients delayed on average only by 12.08 h when compared to primary presenters. Patients who received their surgery in more than 48 h had worse mortality outcomes. Inter-hospital transfer, regardless of time to surgery, was associated with increased mortality.

Conclusion: Increased time to surgery was associated with increased mortality rates. Transfer delays from a peripheral hospital had a significant bearing on time to surgery. Transfer, regardless of time to surgery, is associated with increased mortality. Early transfer to a referral hospital or bypass of the peripheral hospital is recommended.

Keywords: hip fracture; neck of femur fracture; orthogeriatric medicine; orthopaedic surgery; trauma.

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References

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