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Increased wait time to surgery after hip fracture results in adverse outcomes
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ORLANDO, Fla. – Increased wait time to the operating room in patients with hip fractures is associated with greater chance of mortality, Barbara Slawski, MD, MS, said during the “Hospital Medicine Update” here at Hospital Medicine 2018.
“A lot of hospitalists see hip fracture patients. And we know from previous studies that a delay into the operating room might be associated with adverse outcomes,” she said.
Slawski discussed a study in which researchers looked at time to surgery from admission “as a continuous variable ... and identified the threshold at which patients developed adverse outcomes.”
Pincus and colleagues performed the population-based, retrospective study of 42,230 patients who underwent hip fracture surgery at 72 hospitals in Ontario, Canada between April 1, 2009, and March 31, 2014. The mean age of patients was 80.1 years. The probability of each complication according to wait time was modeled with risk-adjusted restricted cubic splines. The primary outcome was 30-day mortality. Other outcomes evaluated included a composite of mortality and medical complications, such as myocardial infarction, deep vein thrombosis, pulmonary embolism and pneumonia. Percent absolute risk differences were used to compare outcomes between early and delayed groups.
At 30 days, the overall mortality rate was 7%. Investigators noted that when the wait times were longer than 24 hours, the complication risk increased, regardless of the complication. The 13,371 patients who underwent surgery after 24 hours had a significantly greater risk for mortality and composite outcome after 30 days compared with the 13,731 propensity score-matched patients who underwent surgery early.
“Only 34% of patients in this study actually made it to the operating room in less than 24 hours and many of us have experienced that this case in hospitals across United States in fracture patients,” Slawski said.
“The authors concluded that an increased wait time to the operating room in hip fracture patients in associated with adverse outcomes and 24 hours appears to be the time at which the threshold increases risk,” she said.
Healio’s full report of this study can be found here. – by Joan-Marie Stiglich, ELS, and Monica Jaramillo
Reference:
Cooper C, Slawski B. Hospital medicine update. Presented at: Hospital Medicine 2018. April 9-11, 2018; Orlando.
Pincus D, et al. JAMA. 2017;doi:10.001/jama.2017.17606.
Disclosure: Slawskis reports no relevant financial disclosures.