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Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey
Victor Novack1, Alan Jotkowitz, Ohad Etzion
1HMS Medcn-BIDMC, Harvard Clinical Research Institute, 930 Commonwealth Avenue, West Boston, MA 02215, USA. victor.novack@hcri.harvard.edu
Objective:
To estimate the impact of delays in surgery for hip fracture on short- and long-term outcomes.
Analysis:
of inpatient hospital data integrated with national health plan data and Central Bureau Statistics.
Setting:
Seven major tertiary hospitals. Patients All consecutive elderly patients admitted with hip fracture during the years 2001-2005.
Main Outcome Measures:
Time from the hospitalization to operation; one-year mortality.
Main Result:
Study population comprise 4633 patients, older than 65 years. The conservative approach was chosen in 818 patients (17.7%), while 1350 patients (29.1%) waited >2 days from admission to the surgery. There was a substantial variation in median pre-operative stay among the hospitals (range 0-4 days). Patients who had surgery within 2 days had lower mortality (in-hospital, 1-month and 1-year) compared to those who waited for surgery >4 days (2.9%, 4.0%, 17.4% vs. 4.6%, 6.1%, 26.2%, respectively). A Cox proportional regression model of 1-year mortality in operated patients adjusted for background morbidity (Charlson index) showed that the length of operation delay has a gradual effect on increasing mortality (<2 days-reference group, 2-4 days-OR = 1.20, 5 days or longer, OR=1.50). The 818 (17.7%) non-operated patients suffered the highest 1-year mortality, 36.2%.
Conclusions:
Delays in surgery for hip fracture are associated with significant increase in short-term and 1-year mortality. Variation among the hospitals was substantial and calls for prompt quality improvement actions.