A three-year retrospective multi-center study on time to surgery and mortality for isolated geriatric hip fractures

• Published in: Journal of clinical orthopaedics and trauma Vol. 11; no. Suppl 1; pp. S56 - S61
• Main Authors: Tanner II, Allen, Jarvis, Stephanie, Orlando, Alessandro, Nwafo, Nnamdi, Madayag, Robert, Roberts, Zachary, Corrigan, Chad, Carrick, Matthew, Bourg, Pamela, Smith, Wade, Bar-Or, David
• Format: Journal Article
• Language: English
• Published: India Elsevier B.V 01.02.2020; Elsevier
• Subjects: Adult Trauma and Reconstruction; Geriatric hip fractures; Long-term mortality; Time to surgery; RR; SBP; TQIP; ACE; OR; Long-term mortality; AOR; CI; HLOS; IQR; AIS; AUC; ASA; SD; SE; Time to surgery; AAOS; Geriatric hip fractures; CDC NDI; COPD; TQIP, Trauma Quality Improvement Program; CI, confidence interval; AUC, area under the curve; COPD, chronic obstructive pulmonary disease; ACE, angiotensin-converting enzyme; IQR, interquartile range; OR, odds ratio; SBP, systolic blood pressure; AOR, adjusted odds ratio; RR, respiratory rate; AIS, Abbreviated Injury Scale; CDC NDI, Centers for Disease Control National Death Index; SE, standard error; SD, standard deviation; ASA, American Society of Anesthesiologists; AAOS, American Academy of Orthopedic Surgeons; HLOS, Hospital Length of Stay
• ISSN: 0976-5662; 2213-3445
• DOI: 10.1016/j.jcot.2019.12.001

There are multiple reports on the effect of time to surgery for geriatric hip fractures; it remains unclear if earlier intervention is associated with improved mortality, hospital length of stay (HLOS), or cost. This was a multi-center retrospective cohort study. Patients (≥65y.) admitted (1/14-1/16) to six level 1 trauma centers for isolated hip fractures were included. Patients were dichotomized into early (≤24 h of admission) or delayed surgery (>24 h). The primary outcome was mortality using the CDC National Death Index. Secondary outcomes included HLOS, complications, and hospital cost. There were 1346 patients, 467 (35%) delayed and 879 (65%) early. The early group had more females (70% vs. 61%, p < 0.001) than the delayed group. The delayed group had a median of 2 comorbidities, whereas the early group had 1, p < 0.001. Mortality and complications were not significantly different between groups. After adjustment, the delayed group had no statistically significant increased risk of dying within one year, OR: 1.1 (95% CI:0.8, 1.5), compared to the early group. The average difference in HLOS was 1.1 days longer for the delayed group, when compared to the early group, p-diff<0.001, after adjustment. The average difference in cost for the delayed group was $2450 ($1550, $3400) more expensive per patient, than the early group, p < 0.001. The results of this study provide further evidence that surgery within 24 h of admission is not associated with lower odds of death when compared to surgery after 24 h of admission, even after adjustment. However, a significant decrease in cost and HLOS was observed for early surgery. If causally linked, our data are 95% confident that earlier treatment could have saved a maximum of $1,587,800. Early surgery should not be pursued purely for the motivation of reducing hospital costs. Level III.