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. 2023 Oct 18:14:21514593231204760.
doi: 10.1177/21514593231204760. eCollection 2023.

Delay to Surgical Treatment in Geriatric Hip Fracture Patients

Elias G Joseph  1 , Jordan Serotte  2 , Mohammad N Haider  3 , Sonja Pavlesen  3 , Mark Anders  3
Affiliations

Delay to Surgical Treatment in Geriatric Hip Fracture Patients

Elias G Joseph et al. Geriatr Orthop Surg Rehabil. .

Abstract

Background: Hip fractures in the geriatric population are frequently encountered. There is increasing focus on minimizing the delay to surgery in these patients. This study was designed to evaluate factors responsible for a delay to surgery in a geriatric hip fracture population and how time to surgery affects mortality.

Methods: A retrospective cohort of patients sustaining low energy geriatric hip fractures in either an American College of Surgeons (ACS) verified Level 1 trauma center or a local university affiliated community teaching hospital were reviewed. The following variables were evaluated as independent risk factors for delay to surgery: demographic data, surgical details, use of cardiology resources, treatment center, and comorbidities. As a secondary objective, the effect of time to surgery on 1 year mortality was analyzed.

Results: 1157 patients met inclusion criteria. The following factors increased the risk of delay to surgery greater than 48 hours: male sex, treatment in a community hospital (versus trauma center), older age, multiple comorbidities (eg, cardiovascular-related conditions or other fractures), cardiology consultation, and an American Society of Anesthesiologists physical status score of 3 or 4. Cardiology consultation was the strongest independent predictor of risk for delay to surgery of >48 hours (odds ratio, 6.68; 95% confidence interval, 4.40 to 10.14; P < .001). The 1-year mortality of patients did not differ when surgical treatment occurred before 48 hours or after 48 hours (Log-rank test P = .109).

Conclusion: The presence of cardiovascular comorbidities and cardiology consultations can delay surgical treatments for hip fractures in patients greater than 65 years old, but the delay did not influence 1-year all-cause mortality.

Level of evidence: Level IV.

Keywords: cardiology; delay to surgery; fragility fractures; geriatric medicine; hip fracture; mortality.

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Conflict of interest statement

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.
Kaplan–Meier survival curve comparing 1-year mortality between patients with a time to surgery of less than or greater than 48 hours.
See this image and copyright information in PMC

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