Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Dr. Alvi is an Adult Joint Reconstruction Orthopedic Surgeon, Barrington Orthopedic Specialists, Schaumburg, Illinois. Dr. Thompson is Assistant Professor, Department of Orthopaedic Surgery, and Associate Director, Center for Cerebral Palsy, David Geffen School of Medicine, The University of California, Los Angeles, Los Angeles, California. Dr. Krishnan is a General Surgery Resident, Lenox Hill Hospital/Northwell Health, New York, New York. Dr. Kwasny is Professor of Preventive Medicine, Department of Preventive Medicine, Biostatistics Collaboration Center, Northwestern University, Chicago, Illinois. Dr. Beal is Associate Professor and Program Director; and Dr. Manning is Associate Professor and Vice Chairman Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Address correspondence to: Hasham M. Alvi, MD, Barrington Orthopedic Specialists, 929 W. Higgins Road, Schaumburg, IL 60195 (tel, 847-285-4200; email, Halvi@barrringtonortho.com).
Hasham M. Alvi, MD Rachel M. Thompson, MD Varun Krishnan, MDMary J. Kwasny, ScD Matthew D. Beal, MD David W. Manning, MD . Time-to-Surgery for Definitive Fixation of Hip Fractures: A Look at Outcomes Based Upon Delay. Am J Orthop.
September 7, 2018
TAKE-HOME POINTS
Time-to-surgery for definitive fixation of hip fractures is a modifiable risk factor.
This study fails to demonstrate a benefit in delaying surgery for medical optimization as there were no time-to-surgery related differences in complications (P = 1.43).
Delay in definitive surgery results in an increase in the total length of stay (P < .001) and surgery-to-discharge time (P < .001) without an improvement in overall complications, readmission or 30-day mortality rates.
Despite numerous investigations, there are no consensus guidelines to decrease complications and mortality rates following hip fracture surgery.
ACS-NSQIP database is a reliable and validated database.
References
ABSTRACT
The morbidity and mortality after hip fracture in the elderly are influenced by non-modifiable comorbidities. Time-to-surgery is a modifiable factor that may play a role in postoperative morbidity. This study investigates the outcomes and complications in the elderly hip fracture surgery as a function of time-to-surgery.
Using the American College of Surgeons-National Surgical Quality Improvement Program data from 2011 to 2012, a study population was generated using the Current Procedural Terminology codes for percutaneous or open treatment of femoral neck fractures (27235, 27236) and fixation with a screw and side plate or intramedullary fixation (27244, 27245) for peritrochanteric fractures. Three time-to-surgery groups (<24 hours to surgical intervention, 24-48 hours, and >48 hours) were created and matched for surgery type, sex, age, and American Society of Anesthesiologists class. Time-to-surgery was then studied for its effect on the post-surgical outcomes using the adjusted regression modeling.
A study population of 6036 hip fractures was created, and 2012 patients were assigned to each matched time-to-surgery group. The unadjusted models showed that the earlier surgical intervention groups (<24 hours and 24-48 hours) exhibited a lower overall complication rate (P = .034) compared with the group waiting for surgery >48 hours. The unadjusted mortality rates increased with delay to surgical intervention (P = .039). Time-to-surgery caused no effect on the return to the operating room rate (P = .554) nor readmission rate (P = .285). Compared with other time-to-surgeries, the time-to-surgery of >48 hours was associated with prolonged total hospital length of stay (10.9 days) (P < .001) and a longer surgery-to-discharge time (hazard ratio, 95% confidence interval: 0.74, 0.69-0.79) (P < .001). Adjusted analyses showed no time-to-surgery related difference in complications (P = .143) but presented an increase in the total length of stay (P < .001) and surgery-to-discharge time (P < .001).
Timeliness of surgical intervention in a comorbidity-adjusted population of elderly hip fracture patients causes no effect on the overall complications, readmissions, nor 30-day mortality. However, time-to-surgery of >48 hours is associated with costly increase in the total length of stay, including an increased post-surgery-to-discharge time.
Continue to: Despite the best efforts to optimize surgical care...