Associations between Hip Fracture Operation Waiting Time and Complications in Asian Geriatric Patients: A Taiwan Medical Center Study

Abstract

Early surgical intervention in hip fractures is associated with lower complications. This study aimed to determine the appropriate operation time among Asian geriatric patients. The data of 1118 elderly patients with hip fracture at Mackay Memorial Hospital from 1 January 2011, to 31 July 2019, were retrospectively examined. Association between operation waiting time and the occurrence of complications was calculated using a cubic spline model. Significantly increased incidence of pneumonia, myocardial infarction, and heart failure was observed in 30 and 90 days when the patient's surgical waiting time exceeded 36 h. The incidence rates of pneumonia across the early and delayed groups within 30 and 90 days were 4.4% vs. 7.9%, and 6.2% vs. 10.7%, those of myocardial infarction were 3.0% vs. 7.2%, and 5.7% vs. 9.3%, and those of heart failure were 15.2% vs. 26.8%, and 16.2% vs. 28.5%. Deep vein thrombosis and pulmonary embolism were not associated with surgical delay. The overall 30-day mortality rate was 5.4%, and no significant difference was observed when the surgical waiting time exceeded 36 h. In summary, operation waiting time exceeding 36-h was associated with increased rates of pneumonia, myocardial infarction, and heart failure in Asian geriatric patients undergoing hip fracture surgery.

Keywords: Asian; complication; geriatric; hip fracture; operation waiting time.

Figure A1

ROC (receiver operating characteristic) analysis in each comorbidity showed a significant difference across early and delayed groups. The analysis revealed that the AUC (area under curve) was the highest when the threshold was 36 h.

Figure 1

Flow chart of patient inclusion.

Figure 2

Probabilities (95% confidence intervals) modeled with cubic splines model. Probabilities of operation waiting time and each medical complication (pneumonia, acute myocardial infarction, heart failure, deep vein thrombosis, and pulmonary embolism) are presented.