The Effect of Time-to-Surgery on Outcome in Elderly Patients with Proximal Femoral Fractures

• Authors: Rüdiger Smektala , Burghard Dasch , Helmut Endres , Michael Lungenhausen , Christoph Mayer , Felix Bonnaire , Hans-Joachim Trampisch , Ludger Pientka
• Languages of publication: EN

Abstracts

EN

There is a controversial debate about whether early surgical treatment of elderly patients with hip fractures yields health benefits.Material and methods. In a prospective observational study of the care provided to hip fracture patients in Germany, the association between time-to-surgery and the frequency of postoperative complications and mortality was examined. The study was conducted between January 2002 and September 2003. We analyzed the data of patients aged 65 and older who underwent surgical treatment for isolated proximal femoral fractures (femoral neck fractures or pertrochanteric femoral fractures). The incidences of postoperative pneumonia, thrombosis or embolism, urinary tract infections, decubitus ulcers, and mortality (in-hospital mortality, one-year mortality) were compared in patients receiving early (≤ 24 h) and late (> 24 h) surgery.Results. Clinical data on 2325 hip patients was available for analysis. The mean age of the study participants was 83.2±7.4; 80.3% of the patients were women. Comparison between patients with early (n=631) and late (n=1694) surgery did not show any statistically significant differences in the frequency of postoperative pneumonia, thrombosis/embolism or urinary tract infections (≤ 24 h vs > 24 h; 2.5% vs 3.9%, p=0.11; 0.79% vs 0.89%, p=0.83; 7.8% vs 9%, p=0.33). However, we did observe that fewer patients undergoing early surgery developed postoperative decubitus ulcers than those undergoing late surgery (1.9% vs 0.6%, p=0.02). A significant relationship between time-to-surgery and in-hospital mortality and/or one-year mortality could not be demonstrated statistically (≤ 24 h vs > 24 h; 3.3% vs 3.5%, p=0.80; 12.5% vs 13.8%, p=0.41).Conclusions. In the present study, a statistically significant association between time-to-surgery and mortality could not be proven. Early surgical treatment, i.e. within 24 hours, significantly reduces the decubitus ulcer rate. This study confirms that elderly patients with femoral fractures in the hip region require surgical treatment within 24 hours.

Keywords

EN

femoral fracture; complications

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2007
• Volume: 79
• Issue: 2
• Pages: 98-105

Dates

published

1 - 2 - 2007

online

24 - 9 - 2007

Contributors

author

Rüdiger Smektala

• Department of Accident Surgery, Knappschaftskrankenhaus Bochum-Langendreer, Ruhr University Bochum, Germany

author

Burghard Dasch

• Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, Germany

author

Helmut Endres

• Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, Germany

author

Michael Lungenhausen

• Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Berufsgenossenschaftliche Kliniken Bergmannsheil Bochum, Ruhr University Hospital Bochum, Germany

author

Christoph Mayer

• Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Berufsgenossenschaftliche Kliniken Bergmannsheil Bochum, Ruhr University Hospital Bochum, Germany

author

Felix Bonnaire

• Accident Surgery Hospital, Dresden Friedrichstadt Hospital, Dresden, Germany

author

Hans-Joachim Trampisch

• Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, Germany

author

Ludger Pientka

• Department of Geriatrics and Early Rehabilitation, Marienhospital Herne, Ruhr University Hospital Bochum, Germany

References

• Kirke PN, Sutton M, Daly L. Outcome of hip fracture in older Irish women: a 2-year follow up of subjects in a case-control study Injury (2002); 33: 387-91.
• Parker MJ, Pryor GA: The Time of Surgery for Proximal Femoral Fractures. J Bone Joint Surg 1992; 294-B: 119-20.
• Zuckerman JD, Skovron ML, Koval KJ et al.: Postoperative Complications and Mortality Associated with Operative Delay in Older Patients Who Have a Fracture of the hip. J Bone Joint Surg Am 1995; 77-A: 1551-56.
• Chilov MN, Cameron ID, March LN: Evidence-based guidelines for fixing broken hips: an update MJA 2003; 179: 489-93.
• Leibson CL, Tosteson ANA, Gabriel SE et al.: Mortality, Disability, and Nursing Home Use with and without Hip Fracture: A Population-Based Study. J Am Geriat Soc 2002; 50: 1644.
• Obertacke U, Nast-Kolb D: Besonderheiten des Unfalls, der Verletzung und der chirurgischen Versorgung im höheren Lebensalter. Unfallchirurg 2000; 103: 227-39.
• Roberts SE, Goldacre MJ: Time trends and demography of mortality after fractured neck of femur in an English population, 1976-98. BMJ 2003; 327: 771.
• Elliot J, Beringer T, Kee F et al.: Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 2003; 56: 788-95.
• Grimes JP, Gregory PM, Noveck H et al.: The effect of Time-to-Surgery on Mortality and Morbidity in Patients following Hip Fracture. Am J Med 2002; 112: 702-09.
• Orosz GM, Hannan EL, Magaziner J et al.: Hip Fracture in Older Patients: Reasons for Delay in Hospitalization and Timing of Surgical Repair. JAGS 2002; 50: 1336-40.
• Stoddart J, Horne G, Devane P: Influence of Pre-operative Medical Status and Delay to Surgery on The Death following a Hip Fracture. ANZ J Surg 2002; 72: 405-07.
• March LM, Chamberlain AC, Cameron ID et al.: How best to fix a broken hip. MJA 1999; 170: 489-94.
• Smektala R, Ohmann C, Paech S et al.: On the prognosis of hip fractures-Assessment of mortality after hip fractures by analysing longitudinal data from acute and rehabilitative care. Unfallchirurg 2005; 108: 927-37.
• Moran ChG, Wenn RT, Sikand M et al.: Early Mortality After Hip Fracture: Is Delay Before Surgery Important? J Bone Joint Surg Am 2005; 87: 483-89.
• Gdalevich M, Cohen D, Yosef D et al.: Morbidity and Mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg 2004; 124: 334-40.
• McGuire KJ, Bernstein J, Polsky D et al.: Delays until Surgery after Hip Fracture Increases. Mortality Clin Ortop 2004; 428: 294-301.
• Doruk H, Mas MR, Yildiz C et al.: The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Archger 2004; 39: 179-85.
• Dorotka R, Schoechtner H, Buchinger W: The influence of immediate surgical treatment of proximal femoral fractures on mortality and quality of life. J Bone Joint Surg 2003; 85-B:1107-13.
• Kenzora JE, McCarthy RE, Lowell JD et al.: Hip Fracture Mortality. Clin Orthop 1984; 186: 45-56.
• Baumgarten M, Margolis D, Berlin J et al.: Risk factors for pressure ulcers among elderly hip fracture patients. Wound Rep Reg 2003; 11: 96-103.
• Casaletto JA, Gatt R: Postoperative mortality related to waiting time for hip fracture surgery Injury. Int J Care Injured 2004; 35: 114-20.
• Orosz GM, Magaziner J, Hannan EL et al.: Association of Timing of Surgery for Hip Fracture and Patient Outcomes. JAMA 2004; 291: 1738-43.
• Sexson SB, Lehner JT: Factors Affecting Hip Fracture Mortality. J Orthop Trauma 1988; 1: 298-305.
• Sund R, Liski A: Quality effects of operative delay on mortality in hip fracture treatment. Qual Saf Health Care 2005; 14: 371-77.
• Thomas S, Ord J, Pailthorpe C: A study of waiting time for surgery in elderly patients with hip fracture and subsequent hospital stay. Ann R Coll Surg Engl 2001; 83: 37-39.
• Whinney CH: Do hip fractures need to be repaired within 24 hours of injury? CME 2005; 72: 250-52.

Identifiers

DOI

10.2478/v10035-007-0016-8