Delayed surgical fixation of fractured hips in older people: impact on mortality

The aim of this project was to ascertain whether increasing delays from admission to surgical repair of hip fractures showed a direct relationship to mortality within the first postoperative year.

It has been recommended that surgical repair of hip fractures should be performed within 24 hours of admission in an effort to reduce postoperative mortality. A literature review of articles relevant to this directive revealed that previous research is conflicting in its findings, and fails to provide conclusive evidence on which to base this recommendation.

Using a retrospective correlational design, Cox Multivariate Regression was used to analyse data from a sample of 381 patients admitted with hip fractures between September 2000 and March 2002. Exclusions from the total accessible population were made in an effort to control bias because of other factors that could contribute to mortality, resulting in 381 patients (64% of total population) being included in the study. All patients in the sample had an American Society of Anaesthesiologists score of 2 or less, were fit for immediate surgery, had an intracapsular or trochanteric fracture, had not had contralateral hip fracture in the previous 2 years, and had presented exclusively with a hip fracture.

There was no relationship between delayed surgery and postoperative mortality (P>0.05) when all other independent variables were controlled. Cognitive dysfunction and reduced prefracture mobility were both good prognostic indicators of increased mortality within the first operative year.

It is important that patients are adequately prepared and resuscitated before surgery is carried out. The nursing contribution to this is paramount. The findings also identify useful information for preparing patient's relatives in relation to prognosis.