Delaying hip fracture surgery increases hospitalization

Patients spend one additional day in the hospital for every 7.85 hours surgery is delayed.

Delaying hip fracture surgery for more than 48 hours significantly increases the length of postoperative hospitalization, new research shows.

Martyn J. Parker, MD, FRCS, and colleagues at the Peterborough District Hospital in Peterborough, England, prospectively followed a consecutive series of hip fracture patients treated at their institution. The study included 3628 patients with a mean age of 81 years; 2124 (59%) had an intracapsular fracture and 1504 (41%) had an extracapsular fracture.

Any patients younger than 60 years old, patients treated conservatively, patients who had a pathological fracture and patients who had a shaft or distal femoral fracture were excluded. The researchers also excluded any patient for whom surgery was delayed for any medical reason or to improve their fitness for surgery, according to the study.

The researchers divided patients into six groups based on the length of time surgery was delayed, as follows:

zero to 12-hour delay, 604 patients;
13 to 24-hour delay, 2089 patients;
25 to 36-hour delay, 496 patients;
37 to 48-hour delay, 265 patients;
49 to 72-hour delay, 125 patients; and
delay of 73 hours or longer, 49 patients.

Most patients — 95.2% — received surgery within 48 hours of admission. In all cases that surgery was delayed, the delay was due to unavailability of an operating theater, surgeon, anesthetist or other surgical staff, the authors noted.

The researchers found no significant differences in length of hospitalization among patients treated within 48 hours. Patients who had surgery delayed for 48 hours or more after admission had significantly longer hospitalizations, however.

Patients treated within 48 hours remained hospitalized for a mean 21.6 days compared with a mean 36.5 days for patients treated after 48 hours (P<.0001), according to the study.

The researchers also found that a significantly greater percentage of patients treated after 48 hours required a change in residence after discharge. Among patients treated within 48 hours, 2974 (86.1%) returned to their original homes vs. 128 (73.6%) of patients treated after 48 hours (P<.0001). More patients treated after 48 hours also required changes in living accommodations — 12.6% (22 patients) compared with 6.9% (240 patients) of those treated within 48 hours (P<.0007).

Additionally, patients treated after 48 hours had a higher mortality rate of 13.8% compared to a 6.9% mortality rate among patients treated within 48 hours. However, after adjusting for American Society of Anesthesiologists grade, mental score and mobility score, delaying surgery did not demonstrate a significant influence on mortality, according to the study.

“Based on our findings, one can expect a further day in hospital bed occupancy for each 7.85 hours of delay to surgery,” the authors said.

“Any delay of more than 48 hours, other than to improve an acute and treatable condition, must be avoided,” they added.

The results were published in the British edition of The Journal of Bone & Joint Surgery.

For more information:
Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br. 2005;87-B:1123-1126.