‘Off-hour’ surgical start times may not affect outcomes, quality of hip fracture repair
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Key takeaways:
- “Off-hour” surgical start times, between 5 p.m. and 6:59 a.m., may not negatively affect outcomes of hip fracture surgery.
- Outcomes were similar vs. surgeries that started during standard hours.
According to published results, “off-hour” surgical start times between 5 p.m. and 6:59 a.m. do not negatively affect hospital quality measures or outcomes of hip fracture surgery.
“Patients and physicians can feel confident that evening or weekend surgical intervention will not negatively impact the ultimate outcome following hip fracture that requires surgery,” Kenneth A. Egol, MD, a co-author of the study, told Healio.
Egol and colleagues at NYU Langone Health performed a retrospective study of data from 2,334 patients aged 55 years or older who underwent surgery for a low-energy hip fracture at an academic medical center between October 2014 and November 2021.
Researchers compared hospital quality measures and outcomes for surgeries that started during standard hours (7 a.m. to 4:59 p.m.; n = 1,836) and off-hours (5 p.m. to 6:59 a.m.; n = 498). They noted trauma and adult reconstruction surgeons operated during off-hours more frequently than orthopedic surgeons from other specialties.
According to the study, researchers performed a subanalysis to examine the quality of reduction for patients whose fractures were reduced (n = 814), as well as rates of inpatient transfusion and postoperative dislocation for patients whose fractures were treated with total hip arthroplasty or hemiarthroplasty (n = 713).
Results showed patients who underwent surgery during off-hours had similar length of stay, time to surgery, inpatient complication rates, mortality and readmissions vs. patients who underwent surgery during standard hours.
In addition, patients who underwent reduction during off-hours had similar tip-apex distance, residual calcar step-off and post-fixation neck-shaft angle as patients treated during standard hours. Similarly, patients who underwent arthroplasty during off-hours had similar rates of transfusions and postoperative prosthetic dislocations as patients treated during standard hours.
“Standardized care protocols for patients like this seem to mitigate differential outcomes for hip fracture patients,” Egol said. “Orthopedic surgeons should try to expeditiously fix hip fractures in the elderly without worrying how the time of surgery will affect the outcomes,” he concluded.
Perspective
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Hip fractures require urgent treatment. As such, orthopedic surgeons will frequently perform these surgeries at “off-hours,” such as the end of the workday or late into the evening. Conventional wisdom suggests that results could be worse at these times due to the fatigue of the surgical team. This study found no difference in hospital or radiographic quality measures in two different types of hip fractures when comparing surgeries performed at normal and off-hours.
This is a well done and interesting study, but it has its limitations. Most hip fracture procedures are routine and can be performed off-hours with no detectable decrease in quality. However, there are occasional complex hip fracture cases that require a significant amount of concentration on the part of the orthopedic team. In these cases, I would imagine there would be a decrease in the quality of the performed procedure if the surgical team is not functioning at full capacity. If simple and complex hip fractures are grouped together such as in this study, then it is unlikely that a difference in quality would be detected as the complex cases would be far outnumbered by the simple cases.
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