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Investigators report high morbidity in elderly patients after hip fracture fixation
Six months after hip fracture fixation, 17% of elderly patients could walk independently and 12% could climb stairs.
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Delayed presentation among elderly patients with hip fractures may negatively affect their ability to walk and increase their rates of morbidity and length of hospital stay postoperatively, according to results of a retrospective study.
David W. Manning, MD, and colleagues analyzed the effects of delayed surgery on elderly patients with hip fractures and found these patients see the most benefits from treatment when surgery is undertaken right away.
“The most unique finding we identified was delay in presentation to surgical care not only lengthened hospital stay on the front end, as one would imagine, but it added hospital time on the back end. It actually significantly lengthened the time from surgery to discharge,” Manning told Orthopaedics Today Europe. “Unnecessary delay for surgery is associated with trends for increasing morbidity, and decreasing value for the care of the hip fracture patients. Delay of care should be avoided whenever possible. Ideally surgery for hip fracture occurs within 48 hours.”
Wait and discharge times correlated
The retrospective study Manning and colleagues conducted is among the top papers scheduled to be presented at the EFORT Congress in Prague in May. They used the 2011 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) to collect data from more than 258 hospitals in 43 U.S. states.
The investigators created triads of less than 24 hours to surgical intervention, 24 hours to 48 hours to surgery, and greater than 48 hours until surgery and matched patients within them by surgery type, gender, age and American Society of Anesthesiologists class.
In the database there were 2,904 subjects with 968 fractures in each triad. When researchers analyzed the time to discharge and delay to surgery for each patient they found a significant correlation between wait-time that was greater than 48 hours and an increased time from surgery to discharge (P < 0.001), according to results of the study.
Delay to surgery at issue
“As the value proposition permeates through all of medicine, including geriatric fracture care, it is pretty clear that from our study the value of surgical care for hip fracture goes down with unnecessary delay to surgical care by increasing associated costs of hospital stay without any benefit in surgical quality,” Manning said in an interview.
Overall, complications do not increase with early surgical intervention in a comorbidity-adjusted population of elderly hip fractures, according to the study data. Furthermore, adjusted and unadjusted models used showed there was no correlation between overall 30-day mortality rates (P = 0.316) or readmission rates (P = 0.593) with wait times. – by Robert Linnehan
- Reference:
- Manning DW, et al. Paper #2218. Scheduled to be presented 27 May at: EFORT Congress; May 27-29, 2015; Prague.
- For more information:
- David W. Manning, MD, can be reached at Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Chicago, IL 60611 USA; email: dmanning@nmff.org.
Disclosure: Manning reports no relevant financial disclosures.