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. 2023 Nov 1;105-B(11):1201-1205.
doi: 10.1302/0301-620X.105B11.BJJ-2023-0597.R1.

Does the time to surgery influence outcomes for patients with a hip fracture who undergo total hip arthroplasty?

Luke Farrow  1   2   3 , Nick D Clement  3   4 , Lewis Mitchell  1 , Mariam Sattar  2 , Alasdair M J MacLullich  3   4   5
Affiliations

Does the time to surgery influence outcomes for patients with a hip fracture who undergo total hip arthroplasty?

Luke Farrow et al. Bone Joint J. .

Erratum in

  • Erratum.
    Farrow L, Clement ND, Mitchell L, Sattar M, MacLullich AMJ. Farrow L, et al. Bone Joint J. 2024 Jan 1;106-B(1):107. doi: 10.1302/0301-620X.106B1.BJJ-2023-00038. Bone Joint J. 2024. PMID: 38160691 No abstract available.

Abstract

Aims: Surgery is often delayed in patients who sustain a hip fracture and are treated with a total hip arthroplasty (THA), in order to await appropriate surgical expertise. There are established links between delay and poorer outcomes in all patients with a hip fracture, but there is little information about the impact of delay in the less frail patients who undergo THA. The aim of this study was to investigate the influence of delayed surgery on outcomes in these patients.

Methods: A retrospective cohort study was undertaken using data from the Scottish Hip Fracture Audit between May 2016 and December 2020. Only patients undergoing THA were included, with categorization according to surgical treatment within 36 hours of admission (≤ 36 hours = 'acute group' vs > 36 hours = 'delayed' group). Those with delays due to being "medically unfit" were excluded. The primary outcome measure was 30-day survival. Costs were estimated in relation to the differences in the lengths of stay.

Results: A total of 1,375 patients underwent THA, with 397 (28.9%) having surgery delayed by > 36 hours. There were no significant differences in the age, sex, residence prior to admission, and Scottish Index of Multiple Deprivation for those with, and those without, delayed surgery. Both groups had statistically similar 30-day (99.7% vs 99.3%; p = 0.526) and 60-day (99.2% vs 99.0%; p = 0.876) survival. There was, however, a significantly longer length of stay for the delayed group (acute: 7.0 vs delayed: 8.9 days; p < 0.001; overall: 8.7 vs 10.2 days; p = 0.002). Delayed surgery did not significantly affect the rates of 30-day readmission (p = 0.085) or discharge destination (p = 0.884). The results were similar following adjustment for potential confounding factors. The estimated additional cost due to delayed surgery was £1,178 per patient.

Conclusion: Delayed surgery does not appear to be associated with increased mortality in patients with an intracapsular hip fracture who undergo THA, compared with those who are treated with a hemiarthroplasty or internal fixation. Those with delayed surgery, however, have a longer length of stay, with financial consequences. Clinicians must balance ethical considerations, the local provision of orthopaedic services, and optimization of outcomes when determining the need to delay surgery in a patient with a hip fracture awaiting THA.

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Conflict of interest statement

L. Farrow, N. D. Clement, and A. M. J. MacLullich are part of the Scottish Hip Fracture Audit (SHFA) Steering Committee which provided the data for the submitted work. L. Farrow is currently in receipt of a Chief Scientist Office Scotland Clinical Academic Fellowship, which is unrelated to the submitted work. N. D. Clement is an Editorial Board member of The Bone & Joint Journal and Bone & Joint Research. L. Mitchell made an unpaid podium presentation using the abstract of this manuscript at the 2022 BOA Annual Congress.

References

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