Delayed Hip Fracture Surgery Linked to Higher Mortality and Complications

surgeon reaching for tools on operating table
surgeon reaching for tools on operating table
Hip fracture repair was linked to higher rates of 30-day mortality and post-operative complications when time between hospital arrival and surgery exceeded 24 hours.

Patients undergoing hip fracture repair experienced higher rates of 30-day mortality and other post-operative complications when time between hospital arrival and surgery exceeded 24 hours, according to data published in JAMA. The 24-hour mark may represent an important inflection point demarcating acceptable early intervention from more delayed efforts.

There is controversy regarding acceptable delays before hip surgery, and guidelines from the United States and Canada differ from those in the United Kingdom. Therefore, the investigators aimed to use this retrospective population-based cohort study to examine data from 42,230 adults who underwent hip repair in an attempt to identify an optimal time for hip fracture surgery.

Participants in the study underwent hip fracture repair between 2009 and 2014. The primary outcome was 30-day mortality rate, while secondary outcomes included a composite of mortality and other serious complications. The mean age was 80.1 years, and 70.5% of the participants were women. Data was evaluated in terms of mortality rate, with early and delayed surgical patients compared using percent absolute risk differences (RDs).

Using the 24-hour mark to divide early from delayed surgery, the researchers found that complications greatly increased past this point, regardless of the nature of the complication. Comparing 2 matched groups of 13,731 individuals, results showed that patients who had surgery after 24 hours had significantly higher 30-day mortality rates than patients receiving treatment earlier (6.5% vs 5.8%; % absolute RD, 0.79; 95% CI, 0.23-1.35; P =.006). For the composite outcome,  12.2%  of participants in the delayed surgery group died within 30 days  vs 10.1% in the early surgery group (absolute RD, 2.16; 95% CI, 1.43-2.89; P <.001).

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The study exhibited several strengths, including use of a population-based sample, as well as the possibility for follow-up due to patients’ participation in a national system. And the use of exact time-to-surgery data allowed researchers to establish a more precise delineation between early and delayed surgeries.

There were also several limitations. First, there were likely confounding factors unaccounted for,  and there were also likely other complications that contributed to surgical delay that were not considered in this study. The analysis also excluded non-operative hip fractures.

The investigators concluded that 24 hours might serve as a useful threshold for early vs delayed surgery, and that “the results of this study may inform existing hip fracture care guidelines and policies.”

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Pincus D, Ravi B, Wasserstein D, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA. 2017;318(20):1994-2003.