Demographics, disparities and delays: why can't geriatric hip fractures get fixed within one day?

Morbidity and mortality following geriatric hip fracture remains high. Increased time from hospital admission to hip fracture surgery is a factor that has been associated with adverse outcomes. The purpose of this study was to identify factors associated with delays to surgery greater than 1 day in geriatric hip fracture patients. The primary aim of this study was to identify and compare comorbidities between patients who underwent surgery within 1 day and those who did not using a large national data base. The null hypothesis was that patients with more acute medical comorbidities would not have a higher association with delays to surgery greater than 1 day.

Patients over the age of 65 who underwent a surgical repair for a hip fracture from 2005 to 2019 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were grouped into those who had surgery less than 1 day after admission (n = 74,072) and those who had surgery greater than 1 day after admission (n = 21,481). Demographic data and comorbidities were collected and compared. Univariate regressions were performed to assess the effect of comorbidities on risk of surgery more than 1 day after admission.

Hip fracture patients who did not undergo surgery within 1 day were older, more likely to be male, non-white, have lower functional status and greater ASA class. These patients had significantly greater preoperative comorbidities such as hypertension, bleeding disorder or anticoagulated status, obesity, chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Patients who were ventilator dependent (OR: 10.09; 95% CI: [6.65, 15.79], p < 0.001), had preoperative transfusions (OR: 3.89; 95% CI: [3.64, 4.16], p < 0.001) or CHF (OR: 2.88, 95% CI: [2.68, 3.09], p < 0.001) had the greatest odds of not having surgery within 1 day.

Hip fracture patients who did not get surgery within 1 day, had a greater preoperative comorbidity profile than those who did. Patients with certain comorbidities such as ventilator dependence, need for preoperative blood transfusion and congestive heart failure had greater odds of having surgery delayed beyond 1 day. Attention should be placed on patients who arrive with these risk factors and clinical pathways should be designed to expedite preoperative medical optimization and surgical treatment.

III; Retrospective Comparative Study.