The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures

• Published in: BMC musculoskeletal disorders Vol. 9; no. 1; p. 171
• Main Authors: Smektala, Rüdiger, Endres, Heinz G, Dasch, Burkhard, Maier, Christoph, Trampisch, Hans J, Bonnaire, Felix, Pientka, Ludger
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.12.2008; BioMed Central; BMC
• Subjects: Age Factors; Aged; Aged, 80 and over; Demographic aspects; Emergency Medical Services - standards; Emergency Medical Services - statistics & numerical data; Female; Femoral Neck Fractures - mortality; Femoral Neck Fractures - surgery; Femur - injuries; Femur - pathology; Femur - surgery; Fracture fixation; Fracture Fixation - adverse effects; Fracture Fixation - standards; Fracture Fixation - statistics & numerical data; Fractures; Hip joint; Humans; Internal Fixators - adverse effects; Internal Fixators - statistics & numerical data; Male; Outcome and process assessment (Health Care); Outcome Assessment (Health Care) - methods; Patient outcomes; Postoperative Complications - mortality; Postoperative Hemorrhage - mortality; Prospective Studies; Prostheses and Implants - adverse effects; Prostheses and Implants - statistics & numerical data; Quality of Health Care - statistics & numerical data; Quality of Health Care - trends; Time Factors; Treatment Outcome; Germany
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/1471-2474-9-171

Whether reducing time-to-surgery for elderly patients suffering from hip fracture results in better outcomes remains subject to controversial debates. As part of a prospective observational study conducted between January 2002 and September 2003 on hip-fracture patients from 268 acute-care hospitals all over Germany, we investigated the relationship of time-to-surgery with frequency of post-operative complications and one-year mortality in elderly patients (age > or =65) with isolated proximal femoral fracture (femoral neck fracture or pertrochanteric femoral fracture). Patients with short (< or =12 h), medium (> 12 h to < or =36 h) and long (> 36 h) times-to-surgery, counting from the time of the fracture event, were compared for patient characteristics, operative procedures, post-operative complications and one-year mortality. Hospital data were available for 2916 hip-fracture patients (mean age (SD) in years: 82.1 (7.4), median age: 82; 79.7% women). Comparison of groups with short (n = 802), medium (n = 1191) and long (n = 923) time-to-surgery revealed statistically significant differences in a few patient characteristics (age, American Society of Anesthesiologists ratings classification and type of admission) and in operative procedures (total hip endoprosthesis, hemi-endoprosthetic implants, other osteosynthetic procedures). However, comparison of these same groups for frequency of postoperative complications revealed only some non-significant associations with certain complications such as post-operative bleeding requiring treatment (early surgery patients) and urinary tract infections (delayed surgery patients). Both unadjusted rates of one-year all-cause mortality (between 18.1% and 20.5%), and the multivariate-adjusted hazard ratios (HR for time-to-surgery: 1.04; p = 0.55) showed no association between mortality and time-to-surgery. Although this study found a trend toward more frequent post-operative complications in the longest time-to-surgery group, there was no effect of time-to-surgery on mortality. Shorter time-to-surgery may be associated with somewhat lower rates of post-operative complications such as decubitus ulcers, urinary tract infections, thromboses, pneumonia and cardiovascular events, and with somewhat higher rates of others such as post-operative bleeding or implant complications.