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Causes for Delay to Surgery in Hip Fractures and How It Impacts on Mortality: a Single Level 1 Trauma Center
A Kristan1, S Omahen1, M Cimerman1
1Division of Surgery, Department of Traumatology, University Medical Centre, Ljubljana, Slovenia.
Insights
Delays in hip fracture surgery are often due to operating room availability, not patient optimization. Patient factors, not surgical timing, significantly impact mortality for hip fracture patients.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Geriatric Medicine
Background:
- Hip fractures represent a significant burden on trauma centers, necessitating efficient treatment protocols.
- Synchronizing hip fracture surgery with other trauma cases can lead to delays.
Purpose of the Study:
- To analyze the reasons for surgical delays in hip fracture patients.
- To determine the impact of these delays on patient mortality.
Main Methods:
- Retrospective study of 641 hip fracture patients over one year.
- Analysis of patient demographics, American Society of Anaesthesiologists (ASA) scores, surgery type, anticoagulant therapy (ACT), and non-routine pre-operative tests (NRPT).
- Comparison of early (<48 hours) versus delayed surgery and their correlation with mortality.
Main Results:
- Surgical delays were influenced by factors such as arthroplasty for femoral neck fractures (FNF), ACT, NRPT, and ASA scores for trochanteric fractures (TF).
- 30-day mortality was 5.1% and 1-year mortality was 18.4%.
- Patient characteristics (ASA, age, preinjury residence) influenced survival, but surgical delay did not.
Conclusions:
- Most delays stem from a lack of available operating capacities, not patient readiness.
- Implementing dedicated operating rooms and teams for hip fractures could mitigate delays.
- Patient-specific factors are key determinants of mortality, underscoring the need for a multidisciplinary approach and skilled surgical teams.
Abstract:
PURPOSE OF THE STUDY The increasing number of hip fractures puts enormous demand on our level 1 trauma centre. Because we have to synchronize hip fracture treatment with all other injuries delays to surgery can occur. In this study, we analysed the reasons for delay to surgery and how it impacts on mortality of hip fracture patients in our institution. MATERIAL AND METHODS We retrospectively studied 641 patients operated for hip fractures in one year period. Investigated characteristics were: age, gender, American Society of Anaesthesiologists score (ASA), time of hospital admission, time of surgery, type of surgery, anticoagulant therapy (ACT) and non-routine pre-operative tests (NRPT). Trochanteric (TF) and femoral neck fractures (FNF) were analysed separately. The surgery in first 48 hours was considered early. The time of death was obtained from the federal database. Univariate and multivariable analysis were performed. P-values <0.05 were considered statistically significant. RESULTS All tested characteristics were significantly different in both time groups. Delay to surgery was significantly influenced by the type of surgery - arthroplasty, odds ratio (OR) 17.2, ACT (OR 6.9) and NRPT (OR 4.0) in FNF group of patients and by ACT (OR 31.1) and ASA (OR 2.2) in TF. 30-day mortality rate was 5.1% and 1-year mortality was 18.4%. ASA (OR 1.9), preinjury residence (OR 1.4) and age (OR 1.1) had statistical influence on survival, but not delay to surgery. CONCLUSIONS The majority of delays are due to unavailability of operative capacities, after patient optimization. We see solution in dedicated operation rooms and teams for hip fracture treatment. Mortality is influenced by the patients' characteristics, but not by delay to surgery. A multidisciplinary approach and skilled surgical teams are, besides early operation, the most important assurance of a good outcome. Key words: trochanteric fracture, femoral neck fracture, timing, mortality.
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