Delays in radiography may increase mortality risk in older patients with hip fractures
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Delays in radiography and surgery may be risk factors for mortality, increased opioid use and prolonged hospital stays in older patients with hip fractures, according to published results.
Researchers from the department of orthopedic surgery at the Johns Hopkins University School of Medicine analyzed information on 511 patients 60 years of age or older who underwent surgical fixation of a hip fracture from Jan. 1, 2015 to Dec. 31, 2017.
Researchers categorized patients into six cohorts according to length of delay in surgery and three cohorts according to length of delay in radiography. Delays in surgery were categorized as 12 hours or less, greater than 12 to 24 hours, greater than 24 to 36 hours, greater than 36 to 48 hours, greater than 48 to 60 hours or greater than 60 hours. Delays in radiography were categorized as short (2 hours or less), medium (greater than 2 to 4 hours) or long (greater than 4 hours).
According to the study, outcomes were determined from electronic health record data including morphine equivalent consumption during the first 24 hours after surgery, duration of hospital stay, 30-day mortality and 1-year mortality.
Mean delay in radiography was 1.8 hours, with 93% of patients experiencing short or medium delays in radiography. After demographic adjustments, researchers found a medium delay in radiography was associated with an additional 11 hours of delay in surgery compared with a short delay in radiography.
Additionally, mean delay in surgery was 38 hours, with 80% of patients experiencing a delay in surgery of 48 hours or less, according to the study. A delay in surgery of greater than 12 hours was associated with use of 9.6 more morphine equivalents compared with delays in surgery of less than 12 hours.
Researchers also noted a delay in surgery of 36 hours or more was associated with increased risk for longer hospital stays and 30-day and 1-year mortality rates.
“These results suggest that ED efficiency (as measured by radiography delay) is associated with shorter surgery delay, even when controlling for known predictors, such as procedure type, day of week and patient factors,” the researchers wrote in the study. “Studies evaluating hospitals with multidisciplinary streamed-care pathways have shown that efficient triage and management of patients with hip fractures significantly reduces surgery delay,” they wrote.
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