Early surgery for patients with a fracture of the hip decreases 30-day mortality

• Published in: Journal of bone and joint surgery. British volume Vol. 97-B; no. 1; pp. 104 - 108
• Main Authors: Bretherton, C P, Parker, M J
• Format: Journal Article
• Language: English
• Published: England 01.01.2015
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Arthroplasty, Replacement, Hip - methods; Confidence Intervals; Databases, Factual; Emergency Treatment - methods; Female; Fracture Fixation, Internal - methods; Fracture Fixation, Internal - mortality; Hip Fractures - diagnostic imaging; Hip Fractures - mortality; Hip Fractures - surgery; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Ontario; Prognosis; Prospective Studies; Radiography; Risk Assessment; Survival Rate; Time Factors; Treatment Outcome; Hip fracture; 12 hours; ASA grade; Early surgery; 30-day mortality
• ISSN: 2049-4394; 0301-620X; 2049-4408
• DOI: 10.1302/0301-620X.97B1.35041

There has been extensive discussion about the effect of delay to surgery on mortality in patients sustaining a fracture of the hip. Despite the low level of evidence provided by many studies, a consensus has been accepted that delay of > 48 hours is detrimental to survival. The aim of this prospective observational study was to determine if early surgery confers a survival benefit at 30 days. Between 1989 and 2013, data were prospectively collected on patients sustaining a fracture of the hip at Peterborough City Hospital. They were divided into groups according to the time interval between admission and surgery. These thresholds ranged from < 6 hours to between 49 and 72 hours. The outcome which was assessed was the 30-day mortality. Adjustment for confounders was performed using multivariate binary logistic regression analysis. In all, 6638 patients aged > 60 years were included. Worsening American Society of Anaesthesiologists grade (p < 0.001), increased age (p < 0.001) and extracapsular fracture (p < 0.019) increased the risk of 30-day mortality. Increasing mobility score (p = 0.014), mini mental test score (p < 0.001) and female gender (p = 0.014) improved survival. After adjusting for these confounders, surgery before 12 hours improved survival compared with surgery after 12 hours (p = 0.013). Beyond this the increasing delay to surgery did not significantly affect the 30-day mortality.